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{{Historic Disclaimer}}
==Volume 30 (1919)==
+
=The Johns Hopkins Medical Journal - Volume 30 (1919)=
  
 
http://www.archive.org/details/johnshopkinsmedi30john
 
http://www.archive.org/details/johnshopkinsmedi30john
  
 
[[The Johns Hopkins Medical Journal 30 (1919)]]
 
[[The Johns Hopkins Medical Journal 30 (1919)]]
 +
 +
[[The Johns Hopkins Medical Journal|The Johns Hopkins Hospital Bulletin]]
 +
 +
VOLUME XXX
 +
 +
BALTIMORE
 +
THE JOHNS FRANKINS PRESS
 +
 +
BALTIMORE, UD., U. 6. A.
 +
 +
 +
Vol. XXX-No. 335
 +
 +
BALTIMORE, JANUARY. 1919
 +
==Contents==
 +
 +
Clinical Observations on Epidemic Influenza. (Illustratcil.)
 +
By Abtiiub Bi.oomkield and George A. Hakrop. Jr.
 +
 +
Tlie Beliavior of tlio Blood Toward Oxygen in Inlliicnziil In
 +
feetions. (Illiistratod.)
 +
 +
Bv (iEOBGK A. Harbop, Jr
 +
 +
Bacteriological Findings in Epideniie Inllneiiza. 1 By S. K. Howard, Jf. D 13
 +
 +
Ectopic Pregnancy. By H. M. X. Wynnk . . . l.O
 +
 +
1 Notes and News 25
 +
 +
10 I Notes on New Books 27
 +
 +
 +
 +
 +
==Ectopic Pregnancy==
 +
 +
 +
 +
By II. M. X
 +
 +
Hes'ideitl (li/necoloriisl. Thr
 +
 +
INCIDENCE
 +
 +
In the 2t years from 1810 to l!tl(i inclusive, there have been 303 patients with ectopic pregnancy in the tiynecological
 +
Service of The Johns Hopkkins Hospital who were operated
 +
upon. There have been 22,fi88 patients admitted to the
 +
Gj-necological Service during the S'i years, of which 303 had
 +
extrauterine pregnancies, an incidence of l.:W.
 +
 +
Table Showino the Nimbeb ok Patients with ExTRAi'n':Ri.NE
 +
PREOXANCIE.S Each Year
 +
 +
 +
1990
 +
 +
 +
2
 +
 +
 +
18«!
 +
 +
 +
6
 +
 +
 +
1902
 +
 +
 +
8
 +
 +
 +
1908
 +
 +
 +
23
 +
 +
 +
1014
 +
 +
 +
14
 +
 +
 +
1891
 +
 +
 +
3
 +
 +
 +
18(t7
 +
 +
 +
1
 +
 +
 +
1003
 +
 +
 +
15
 +
 +
 +
190U
 +
 +
 +
23
 +
 +
 +
1915
 +
 +
 +
13
 +
 +
 +
1892
 +
 +
 +
4
 +
 +
 +
1 898
 +
 +
 +
8
 +
 +
 +
1!X)4
 +
 +
 +
23
 +
 +
 +
IftlO
 +
 +
 +
13
 +
 +
 +
1010
 +
 +
 +
13
 +
 +
 +
isns
 +
 +
 +
8
 +
 +
 +
18it!t
 +
 +
 +
7
 +
 +
 +
HI05
 +
 +
 +
23
 +
 +
 +
I91I
 +
 +
 +
16
 +
 +
 +
 +
 +
 +
 +
I8»4
 +
 +
 +
7
 +
 +
 +
lOOO
 +
 +
 +
10
 +
 +
 +
1900
 +
 +
 +
13
 +
 +
 +
1912
 +
 +
 +
11
 +
 +
 +
 +
 +
 +
 +
1895
 +
 +
 +
'
 +
 +
 +
1901
 +
 +
 +
10
 +
 +
 +
1907
 +
 +
 +
10
 +
 +
 +
1913
 +
 +
 +
11
 +
 +
 +
Total
 +
 +
 +
.103
 +
 +
 +
 +
Race— Negroes, 101; white, 202. Total, 303.
 +
 +
Of the.s(. 22.688 patients. i:.H2 were wliit.- and .">2:(i wer.'
 +
negroes. There were 202 eases of extrauterine pregnancy
 +
among the whites (1.16:^) and 101 among the negro»
 +
(l.'.il^).
 +
 +
 +
 +
Wynne.
 +
 +
Johns Ilopkins IlosjiHa]
 +
 +
AGE
 +
 +
(»f this .series of cases the age was rccnnlcil :>()() tunes. The
 +
youngest patient was a 1 ."i-ycar-old white girl, married .seven
 +
months previously to admission and never pregnant Ix'fore.
 +
.\n unruptured left tubal |)rcgi»Hncy was removed at operation. The oldest jjaticnt was a l.")-year-old ncgress, who had
 +
given birth to three full-term chihircn. .\t operation a fullterm litiiopedion. which iiad been in thf aiidomcn for four
 +
years was removed ( Kcjiorted by .1. (i. Clark, The .lohns Hopkins Hospital Bulletin. l«!i:. Vlll. and in Kelly's Operative
 +
Gynecology, Vol. 11). Of this series 182 (GH) occurred in
 +
the decade 24 to .5.3 years inclusive. Seven patietits were
 +
under 20 years and ten were over 10 years of age.
 +
 +
TAni.K Showixo Aokh ok 300 Patik.nth
 +
 +
 +
 +
 +
MARITAL HISTORY
 +
 +
In a series of 284 there were 14 unmarried, two widows
 +
and nine twice married.
 +
 +
 +
 +
Table Showing Time of Admission Aftee
 +
 +
 +
Marriage
 +
 +
 +
Time
 +
 +
 +
Number
 +
 +
of
 +
patients
 +
 +
 +
Time
 +
 +
 +
Number
 +
 +
of
 +
patients
 +
 +
 +
Time
 +
 +
 +
Number
 +
 +
of
 +
patients
 +
 +
 +
Time
 +
 +
 +
Number
 +
 +
of
 +
patients
 +
 +
 +
married
 +
 +
 +
married
 +
 +
 +
married
 +
 +
 +
married
 +
 +
 +
 +
 +
 +
 +
yrs.
 +
 +
 +
 +
 +
yrs.
 +
 +
 +
 +
 +
yrs.
 +
 +
 +
 +
 +
2 wks . . .
 +
 +
 +
 +
 +
1
 +
 +
 +
9
 +
 +
 +
9
 +
 +
 +
8
 +
 +
 +
18
 +
 +
 +
9
 +
 +
 +
4 wks...
 +
 +
 +
 +
 +
2
 +
 +
 +
22
 +
 +
 +
10
 +
 +
 +
14
 +
 +
 +
19
 +
 +
 +
3
 +
 +
 +
6 wks...
 +
 +
 +
 +
 +
3
 +
 +
 +
18
 +
 +
 +
11
 +
 +
 +
9
 +
 +
 +
20
 +
 +
 +
7
 +
 +
 +
2 mo8. . .
 +
 +
 +
 +
 +
4
 +
 +
 +
13
 +
 +
 +
12
 +
 +
 +
17
 +
 +
 +
21
 +
 +
 +
6
 +
 +
 +
4 mos. . .
 +
 +
 +
 +
 +
5
 +
 +
 +
I.i
 +
 +
 +
13
 +
 +
 +
11
 +
 +
 +
22
 +
 +
 +
2
 +
 +
 +
5 mos. . .
 +
 +
 +
 +
 +
6
 +
 +
 +
12
 +
 +
 +
14
 +
 +
 +
8
 +
 +
 +
23
 +
 +
 +
3
 +
 +
 +
7 mos . . .
 +
 +
 +
 +
 +
7
 +
 +
 +
21
 +
 +
 +
1.5
 +
 +
 +
9
 +
 +
 +
20
 +
 +
 +
1
 +
 +
 +
8 mos . . .
 +
 +
 +
 +
 +
8
 +
 +
 +
13
 +
 +
 +
16
 +
 +
 +
6
 +
 +
 +
27
 +
 +
 +
1
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
17
 +
 +
 +
8
 +
 +
 +
Total
 +
 +
 +
268
 +
 +
 +
 +
PREVIOUS PREGNANCIES
 +
 +
In the histories of 375 patients, the number of pregnancies
 +
prior to the ectopic pregnancy was recorded. In 57 (31^)
 +
there had been no previous pregnancy and of the 218 (79^)
 +
who had been pregnant before, 307 (95;?;), 75^ of the whole
 +
series, had given birth to full-term babies and 11 (5^), 4^ of
 +
the whole series, had had only miscarriages. Instrimiental deliveries had been performed on 19 patients (9;^ of those who
 +
had had full-term pregnancies). Histories of prolonged puerperia associated with chills, fever and abdominal pain were obtained from 38 patients (17.5^ of all patients previously
 +
pregnant) .
 +
 +
 +
 +
Table Showing Number of Previous Pregnancies
 +
 +
 +
Number
 +
 +
 +
Number
 +
of
 +
 +
 +
Number
 +
of
 +
 +
 +
Number
 +
of
 +
 +
 +
Total
 +
 +
 +
Number
 +
of
 +
 +
 +
carriages
 +
 +
 +
patients
 +
 +
 +
children
 +
 +
 +
patients
 +
 +
 +
 +
 +
patients
 +
 +
 +
1
 +
 +
 +
65
 +
 +
 +
1
 +
 +
 +
77
 +
 +
 +
 +
 +
 +
57
 +
 +
 +
2
 +
 +
 +
25
 +
 +
 +
2
 +
 +
 +
32
 +
 +
 +
1
 +
 +
 +
67
 +
 +
 +
3
 +
 +
 +
8
 +
 +
 +
3
 +
 +
 +
27
 +
 +
 +
2
 +
 +
 +
42
 +
 +
 +
4
 +
 +
 +
5
 +
 +
 +
4
 +
 +
 +
21
 +
 +
 +
3
 +
 +
 +
22
 +
 +
 +
5
 +
 +
 +
2
 +
 +
 +
5
 +
 +
 +
17
 +
 +
 +
4
 +
 +
 +
22
 +
 +
 +
6
 +
 +
 +
2
 +
 +
 +
6
 +
 +
 +
14
 +
 +
 +
o
 +
 +
 +
16
 +
 +
 +
 +
 +
 +
 +
7
 +
 +
 +
8
 +
 +
 +
6
 +
 +
 +
16
 +
 +
 +
Tola
 +
 +
 +
1 107
 +
 +
 +
8
 +
 +
 +
2
 +
 +
 +
7
 +
 +
 +
13
 +
 +
 +
 +
 +
 +
 +
9 .
 +
 +
 +
2
 +
 +
 +
8
 +
 +
 +
8
 +
 +
 +
 +
 +
 +
 +
10
 +
 +
 +
3
 +
 +
 +
9
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
11
 +
 +
 +
1
 +
 +
 +
10
 +
 +
 +
3
 +
 +
 +
 +
 +
 +
 +
12
 +
 +
 +
 +
 +
 +
11
 +
 +
 +
1
 +
 +
 +
 +
 +
 +
 +
13
 +
 +
 +
1
 +
 +
 +
12
 +
 +
 +
1
 +
 +
 +
 +
 +
 +
 +
14
 +
 +
 +
2
 +
 +
 +
13
 +
14
 +
 +
 +
1
 +
 +
1
 +
 +
 +
 +
 +
 +
 +
Tota
 +
 +
 +
1 207
 +
 +
 +
15
 +
16
 +
 +
 +
1
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
Total 275
 +
 +
 +
 +
The interval between the last pregnancy and admission to
 +
the hospital for an ectopic pregnancy was noted in the his
 +
Table Showing the Interval Between the Last Pregnancy and
 +
Admission to the Hospital for Ectopic Pregnancy
 +
 +
 +
 +
 +
 +
"oS
 +
 +
 +
 +
 +
•5Z
 +
 +
 +
 +
 +
- »i
 +
 +
 +
 +
 +
• a
 +
 +
 +
 +
 +
»- n
 +
 +
 +
 +
 +
aj S
 +
 +
 +
 +
 +
fc. g
 +
 +
 +
 +
 +
t- g
 +
 +
 +
 +
 +
tM C
 +
 +
 +
 +
 +
b. a
 +
 +
 +
1
 +
 +
 +
ft
 +
 +
 +
1
 +
 +
 +
 +
 +
i
 +
 +
 +
It
 +
 +
 +
1
 +
 +
 +
it
 +
 +
 +
1
 +
 +
 +
 +
 +
B
 +
 +
 +
z
 +
 +
 +
B
 +
 +
 +
z
 +
 +
 +
B
 +
 +
 +
S5
 +
 +
 +
B
 +
 +
 +
§.
 +
 +
 +
E
 +
 +
Iz
 +
 +
 +
mos.
 +
 +
 +
 +
 +
mo:.
 +
 +
 +
 +
 +
yrs.
 +
 +
 +
 +
 +
yrs.
 +
 +
 +
 +
 +
yrs.
 +
 +
 +
 +
 +
3
 +
 +
 +
 +
 +
9
 +
 +
 +
5
 +
 +
 +
3
 +
 +
 +
23
 +
 +
 +
9
 +
 +
 +
5
 +
 +
 +
15
 +
 +
 +
3
 +
 +
 +
4
 +
 +
 +
 +
 +
10
 +
 +
 +
1
 +
 +
 +
4
 +
 +
 +
22
 +
 +
 +
10
 +
 +
 +
8
 +
 +
 +
16
 +
 +
 +
1
 +
 +
 +
5
 +
 +
 +
 +
 +
11
 +
 +
 +
2
 +
 +
 +
5
 +
 +
 +
13
 +
 +
 +
11
 +
 +
 +
4
 +
 +
 +
17
 +
 +
 +
1
 +
 +
 +
6
 +
 +
 +
 +
 +
12
 +
 +
 +
20
 +
 +
 +
6
 +
 +
 +
20
 +
 +
 +
12
 +
 +
 +
6
 +
 +
 +
18
 +
 +
 +
1
 +
 +
 +
7
 +
 +
 +
 +
 +
18
 +
 +
 +
15
 +
 +
 +
7
 +
 +
 +
19
 +
 +
 +
13
 +
 +
 +
1
 +
 +
 +
19
 +
 +
 +
2
 +
 +
 +
8
 +
 +
 +
 +
 +
2
 +
 +
 +
36
 +
 +
 +
8
 +
 +
 +
5
 +
 +
 +
14
 +
 +
 +
1
 +
 +
 +
Total
 +
 +
 +
226
 +
 +
 +
 +
tories of 226 patients, the shortest interval being three months
 +
and the longest 19 years. The interval was between one and
 +
seven years iu 168 patients (74^).
 +
 +
PREVIOUS OPERATIONS
 +
 +
Forty-five patients had had operations prior to admission
 +
for ectopic pregnancy.
 +
 +
Dilatation and curettage had been performed on 15 patients
 +
for bleeding caused by the ectopic pregnancy; two of these
 +
operations were done in this hospital. One patient was
 +
curetted twice before admission for bleeding caused by the
 +
ectopic pregnancy.
 +
 +
Curettage was performed on 13 patients, from one to five
 +
years before their admission and simple dilatation of the
 +
cervix twice for sterility.
 +
 +
Incision of Bartholin gland abscess, five years before; one
 +
patient.
 +
 +
Pelvic puncture for inflammatory disease; three patients.
 +
 +
E.rplorafori/ laparotomy five years before; one patient.
 +
 +
Multiple myomectomy five years before; one patient.
 +
 +
Ovarian tumor removed; one patient.
 +
 +
Tu.nior removed and appendectomy; six years before; one
 +
patient.
 +
 +
Parovariancystectomy, right; suspension of uterus; appendectomy; two years before (Gyn. No. 16,409).
 +
 +
Suspension of tderus and appendectomy ; 18 months before
 +
(Gyn. No. 15,751).
 +
 +
Salpingo-oopliorectomy, left, and appendectomy; one and
 +
two years ago, for chronic pelvic inflammatory disease; two
 +
patients.
 +
 +
Salpingo-odphorectomy, right, and appendectomy ; one
 +
patient.
 +
 +
Appendectomy (only) ; three patients.
 +
 +
Appendectomy and nephropexy were done in another city
 +
on one patient for the symptoms caused by a right tubal
 +
pregnancy about six and eight weeks prior to admission to
 +
this hospital.
 +
 +
Five patients have been operated upon twice in this hospital
 +
for ectopic pregnancy.
 +
 +
Pelvic puncture, once.
 +
 +
Salpingectomy (alone), twice.
 +
 +
Salpingo-odphorectomy, twice.
 +
 +
COMPLAINT
 +
 +
The symptoms that patients complained of on admission
 +
were as follows :
 +
 +
Bleeding 93
 +
 +
Pain, general abdominal or not specified 99
 +
 +
Pain in lower abdomen 69
 +
 +
Pain in riglit lower quadrant of abdomen 33
 +
 +
Pain in left lower quadrant of abdomen 33
 +
 +
Pain in back 20
 +
 +
Pain designated as "bearing-down," 4 times: and as "cramplike," 4 times.
 +
 +
Tumor in abdomen 17
 +
 +
Tumor in right lower quadrant of abdomen 1
 +
 +
Tumor in left lower quadrant of abdomen 4
 +
 +
Swelling of abdomen 3
 +
 +
Tenderness of abdomen 4
 +
 +
 +
 +
January, 1919]
 +
 +
 +
17
 +
 +
 +
 +
Pregnancy 2
 +
 +
.Miscarriage I
 +
 +
Amenorrhea 1
 +
 +
Dysmenorrhoea 2
 +
 +
Vomiting 9
 +
 +
Nausea 6
 +
 +
Diarrhoea 1
 +
 +
Pain on defecation 1
 +
 +
Dysuria 2
 +
 +
PoUakiuria 1
 +
 +
Fainting 1
 +
 +
From the foregoing list we see that the most i-oiumon
 +
causes for which these patients seek medical attention are
 +
pain, complained of by 254 (84;^) bleeding, complained of
 +
by 93 (31j^) and tumor, complained of by 28 patients (7^).
 +
 +
SYMPTOMS
 +
Onset (1) Acute without prodromal symptoms other
 +
 +
than bleeding or a missed period 14(> (48%)
 +
 +
(2) Acute with prodromal symptoms 72 (247c)
 +
 +
(3) Gradual without acute attacks 84 (28%)
 +
 +
Irregular bleeding 229 (76%)
 +
 +
Nausea 146 (48%,)
 +
 +
Vomiting 126 (42% )
 +
 +
Tumor 45 (15%)
 +
 +
Fainting 38 (137c)
 +
 +
Fever 29 (IO70)
 +
 +
Chills 12 (47c)
 +
 +
Weakness 87 (29% )
 +
 +
Defecation painful 28 (9% )
 +
 +
Urinary frequency 40 ( 13% )
 +
 +
Burning on voiding 27 (9% )
 +
 +
Pain on voiding 87 (29%)
 +
 +
Loss of weight 6 (2% )
 +
 +
Bad taste In mouth 3 ( 17c )
 +
 +
Patients believing themselves to be pregnant 11
 +
 +
Patients not suspecting pregnancy 3
 +
 +
Patients suspecting an abortion 1
 +
 +
Patients who had felt life 1
 +
 +
Patients having a sensation of fluid in the abdomen. ... 1
 +
Patients who had passed complete casts of the uterus. . 2
 +
Patients complaining of pain in the abdomen not otherwise qualified 131 (437o)
 +
 +
Pain, general abdominal 21 (7%)
 +
 +
Pain, limited to the lower abdomen 28 (9%)
 +
 +
Pain, limited to the lower left quadrant 43 (14% )
 +
 +
Pain, limited to the lower right quadrant 41 (137o)
 +
 +
Abdominal pain over pelvis, with pain in the epigastrium 2
 +
Abdominal pain over pelvis, with pain In the umbilical
 +
 +
region 1
 +
 +
Abdominal pain over pelvis, with pain in the bladder. . . 1
 +
Abdominal pain over pelvis, with pain in the rectum. ... 2
 +
Abdominal pain over pelvis, with pain in the flanks. ... 2
 +
Abdominal pain over pelvis, with pain In the thighs. ... 1
 +
 +
Abdominal pain over pelvis, with pain In the legs 2
 +
 +
Abdominal pain over pelvis, with pain in the right
 +
 +
shoulder 2
 +
 +
.\bdominal pain over pelvis, with pain in the chest 1
 +
 +
Patients complaining of backache 19
 +
 +
Patients complaining of headache 2
 +
 +
fowl. — The symptoms that a patient considers as sufliriently unusual to cause her to seek medical attention an'
 +
produced in the vast majority of cases by intraperitoneal
 +
bleeding. A history of abdominal pain was procured from
 +
 +
 +
 +
300 patients (yiW), the other three patients stated positively
 +
that there had been no abdominal pain or discomfort and
 +
they came to the clinic on account of irregular bleeding. In
 +
each of these three patients an unruptured tubal pregnancy
 +
was found at operation, but no evidence of any clot or free
 +
blood in the jicritoneal cavity.
 +
 +
The onset of the symptoms may be acute without other
 +
prodromal symptoms, although there is usually a history of
 +
a missed period or of irregular bleeding. In a second type
 +
there is an acute attack following prodromal symptoms, which
 +
the patient sometimes ascribes to her pregnancy. A third
 +
type of patient gives a history of gradual onset without an
 +
acute attack.
 +
 +
Recurring attacks of pain occurred in 102 cases (34^) ;
 +
seventeen patients complained especially of soreness and
 +
tenderness, ratlier than of definite pains. In several instances the pain was of several years' duration, generally with
 +
a recent exacerbation, but in each instance at operation some
 +
other condition, usually chronic pelvic inflammatorj- disease,
 +
was also present.
 +
 +
The pains seem rarely to radiate. Tlie character of the
 +
pain was described as violent, agonizing or severe in 90 cases,
 +
cramping in 41, colicky in four, bearing down in 14, laborlike in nine, shooting, cutting or sticking in si.\ and as dull
 +
or aching in 29.
 +
 +
Pain or irritation in the rectum and l)ladder occur after
 +
intraperitoneal hemorrliage, most often when clots have collected in the pelvis and adhesions have formed. Pain and
 +
vaginal bleeding often occur about the same time. Myssey
 +
(St. Paul Med. Jour.. ]!)14, XVI, 588) states that pain on
 +
defecation is almost pathognomonic of the condition, but in
 +
our experience, this symptom is also frequently present in
 +
cases of pelvic inflammatory disease.
 +
 +
MENSTRUAL HISTORY
 +
One hundred and three patients (34'ii) stated definitely
 +
that they had missed one or more periods; and 31 (10;^) said
 +
that their last period had been overdue for from one to five
 +
weeks, while 52 (IT"^) had noticed that the last period was
 +
abnormal in some other respect.
 +
 +
 +
 +
 +
 +
Number
 +
 +
 +
Number
 +
 +
 +
Number
 +
 +
 +
 +
 +
of periods
 +
 +
 +
ol
 +
 +
 +
o( period!
 +
 +
 +
ol
 +
 +
 +
 +
 +
mined
 +
 +
 +
patienta
 +
 +
 +
mined
 +
 +
 +
patients
 +
 +
 +
 +
 +
1
 +
 +
 +
42
 +
 +
 +
7
 +
 +
 +
1
 +
 +
 +
 +
 +
2
 +
 +
 +
14
 +
 +
 +
8
 +
 +
 +
2
 +
 +
 +
 +
 +
:<
 +
 +
 +
14
 +
 +
 +
9
 +
 +
 +
 +
 +
 +
 +
 +
4
 +
 +
 +
2
 +
 +
 +
lU
 +
 +
 +
3
 +
 +
 +
 +
 +
5
 +
 +
 +
4
 +
 +
 +
11
 +
 +
 +
1
 +
 +
 +
 +
 +
(t
 +
 +
 +
U
 +
 +
 +
Total
 +
 +
 +
. .1U3 patients.
 +
 +
 +
 +
 +
 +
Increased frequency of menstruation 14
 +
 +
Constant bleeding since last period 60
 +
 +
No irregular bleeding 49
 +
 +
No irregular bleeding and no periods missed 18
 +
 +
Periods normally regular 210
 +
 +
Periods normally irregular 30
 +
 +
 +
 +
18
 +
 +
 +
[No. 333
 +
 +
 +
 +
Last menstrual period :
 +
 +
Overdue 1 week 11
 +
 +
Overdue 2 weeks 1 1"
 +
 +
Overdue 3 weeks 2
 +
 +
Overdue 4 weeks 1
 +
 +
Overdue 5 weeks 1
 +
 +
Ahead of regular time 12
 +
 +
Shorter than usual 5
 +
 +
Longer than usual 2ii
 +
 +
Flow decreased 1^
 +
 +
Flow increased 9
 +
 +
Color abnormal 5
 +
 +
Xausea and vomiting occurred in a few cases, as in normally pregnant women and the patients with these symptoni>
 +
considered themselves pregnant. In the great majority, however, there was a history pointing to intraperitoneal hemorrhage before nausea or vomiting had occurred.
 +
 +
Abdominal masses were noticed by the patients in cases of
 +
advanced pregnancy and wliere a walled-otf hematocele was
 +
present.
 +
 +
Fainting occurred in some cases wliere there was profuse
 +
intraperitoneal hemorrhage.
 +
 +
Chills and fever were unusual .symptoms and always suggested the gravest complications.
 +
 +
Weakness is generally present in the more anaemic.
 +
 +
Loss of weight was noticed only in advanced tubal pregnancy, as also was the complaint of a bad taste in the mouth.
 +
 +
The notes in our histories as to whether the patient considered herself pregnant are very incomplete, and no conclusions
 +
can be drawn from them except that not all believed that they
 +
were pregnant.
 +
 +
SIGNS
 +
 +
In the following tabulation of physical signs, it is notable
 +
that many of the presumptive signs of intrauterine pregnancy are not present in the majority of this series of ectopic
 +
pregnancies. In the larger percentage of the cases in which
 +
the table gives " a softened and enlarged cervix or fundus "
 +
the notes Avere " slightly softened " or " slightly enlarged "
 +
and often there was a difference of opinion in those cases examined by two men. We believe that most cases of tubal
 +
pregnancy show no very definite gross changes in the cervix
 +
and uterine body, unless the foetus is living. In no case was
 +
a positive Hegar's sign recorded. Vaginal cyanosis was not
 +
marked in any case.
 +
 +
The usual aksence of definite muscle spasm or rigidity is
 +
in accordance with the signs of most pelvic diseases and,
 +
where present, there was invariably blood in the peritoneal
 +
cavity, not confined to the pelvis. Voluntary resistance to
 +
deep pressure was a very common sign.
 +
 +
Abdominal tenderness was frequently alj.sent in cases of
 +
pelvic hematocele ; in unruptured tubal pregnancy and in
 +
advanced cases, but in patients who had had a recent severe
 +
hemorrhage, the abdomen was generally exquisitely tender.
 +
 +
The figures recorded on pelvic tenderness are undoubtedly
 +
too low. Certainly in those patients that have been under my
 +
ob.servation, there is usually marked tenderness, and. especially when the pelvis is filled with recent clots, tliere is an
 +
 +
 +
 +
even greater degree of tenderness than is found in cases of
 +
pelvic abscess. I have seen two eases of unruptured tubal
 +
pregnancy in which firm bimanual compression of the mass
 +
elicited no tomplaint or discomfort, but they are very unusual.
 +
 +
Signs ox Physical Examination
 +
Shock (extreme) 15
 +
 +
Breasts:
 +
 +
Lactating 7
 +
 +
Colostrum present 46 (15%)
 +
 +
Abdomen:
 +
 +
Distention 90 (30%)
 +
 +
Free fluid 33 (10%)
 +
 +
Mass 72 (24%)
 +
 +
Tenderness, general 21 (7%)
 +
 +
Tenderness, limited to lower abdomen 71 (23%)
 +
 +
Tenderness, limited to lower right quadrant 52 (17%)
 +
 +
Tenderness, limited to lower left quadrant 39 (13%)
 +
 +
Muscle spasm 11 (4%)
 +
 +
Rigidity 17 (6%)
 +
 +
Pelvis:
 +
 +
Vaginal cyanosis 6 (2%)
 +
 +
Bloody discharge from vagina 85 (25%)
 +
 +
Cervix softened 85 (25%)
 +
 +
Cervix enlarged 48 (16%)
 +
 +
Fundus softened 15 (5%)
 +
 +
Fundus enlarged 86 (25%)
 +
 +
Mass, boggy 83 (24%)
 +
 +
Mass, firm 38 (12%)
 +
 +
Mass, cystic 40 (13%)
 +
 +
Blood clot crepitus 21 (7%)
 +
 +
Tenderness 146 (48%)
 +
 +
HEMOGLOBIN AND LEUCOCYTE COUNT
 +
 +
Unfortunately, hemoglobin determinations and leucocyte
 +
counts were not done in many of the cases. It is to be remembered that the lowest point of the hemoglobin curve is
 +
not obtained until from 48 to 72 hours after an acute hemorrhage (Dunn & AVynne, John Hopkixs Hospital Bulletin,
 +
XXIX, No. 323, January, 1918). On this account, the degree
 +
of ananiiia caused by the acute hemorrhage is not determined
 +
as a rule before operation. A high leucocyte count is usually
 +
found shortly after acute intrajieritoneal hemorrhage and cannot by itself be considered an indication of infection. In our
 +
small series of leucocyte counts, there were between 20,000 and
 +
30,000 leucocytes in 8 cases (10^) and between 10,000 and
 +
20,000 in 39 cases (-17.5^). Tliis observation agrees with
 +
those reported by other authors.
 +
 +
 +
 +
 +
 +
Hemoglobin
 +
 +
 +
Before Operation
 +
 +
 +
Per cent
 +
of
 +
 +
hemoglobin
 +
 +
 +
Number
 +
of
 +
 +
patients
 +
 +
 +
Per cent
 +
of
 +
 +
hemoglobin
 +
 +
 +
Number
 +
 +
of
 +
patients
 +
 +
 +
15
 +
 +
20-30
 +
30-40
 +
40-.')0
 +
50-60
 +
 +
 +
1
 +
3
 +
13
 +
 +
7
 +
19
 +
 +
 +
60-70
 +
70-80
 +
80-90
 +
90-100
 +
 +
 +
18
 +
 +
20
 +
 +
16
 +
 +
9
 +
 +
 +
 +
Total number of patients on whose blood hemoglobin determinations were done prior to operation, 106.
 +
 +
 +
 +
.I.\NIUHY, 1919]
 +
 +
 +
19
 +
 +
 +
 +
LEfcocvTE Count Before Opebatio.n
 +
 +
 +
W. B. c.
 +
 +
 +
No. of
 +
patienta
 +
 +
 +
\v. B. r.
 +
 +
 +
No. of
 +
patienta
 +
 +
 +
\V. B. C.
 +
 +
 +
No. of
 +
patients
 +
 +
 +
3.000
 +
 +
5,000-6,000
 +
 +
6,000-7 ,00t)
 +
 +
7,00ft-8.0OO
 +
 +
8,000-9,000
 +
 +
9,000-10.000
 +
 +
 +
1
 +
 +
2
 +
 +
6
 +
 +
.;
 +
 +
 +
10.000-11.000
 +
11,000-12.000
 +
12.00(UI3.00()
 +
13.0<K»-14,00«1
 +
14.000-l.i.llOO
 +
15,000-16,000
 +
 +
 +
12
 +
 +
I
 +
8
 +
 +
4
 +
 +
t>
 +
 +
 +
Ifi. 000-17. 000
 +
W.OOO-IS.IMHI
 +
IS.OOO-lO.tKMt
 +
20,000-21.000
 +
22.000-23,000
 +
30.000
 +
 +
3
 +
 +
1
 +
 +
1
 +
5
 +
2
 +
 +
 +
 +
Total number of patients on whom leucocyte counts were made
 +
before operation, 82.
 +
 +
TEMPERATURE AND PULSE
 +
 +
The temperature on ailnii^t^ion to tlie hospital was less tliaii
 +
101° F. ill 164 (9H) of a series of 180 eonsci-utive adiiiissions for ectopic jrestiition and the pulse was loss tlian I'iO
 +
jH?r minute in the same number of patients. The majority
 +
sliowed .some increase in both ]iulse rate and temperature.
 +
 +
Temperatire axi> Pfi-.sK ON Akmissiox to the Hospital of 180
 +
 +
Co.NSEClTIVE PaTIE.NTS
 +
 +
 +
 +
Teraperalure
 +
 +
 +
No. of
 +
patienta
 +
 +
 +
Temperature
 +
 +
 +
No. of
 +
patienta
 +
 +
 +
Temperature
 +
 +
 +
No. of
 +
patients
 +
 +
 +
Did not
 +
reginter. . .
 +
97.0-98.0
 +
98.0-98.5
 +
98. .5-99.0
 +
99.0-99.5
 +
 +
 +
1
 +
 +
.10
 +
26
 +
41
 +
 +
 +
99.5-100
 +
100.0-100.5
 +
100.5-101
 +
101.0-101.5
 +
101.5-102
 +
 +
 +
2!)
 +
30
 +
8
 +
5
 +
3
 +
 +
 +
102.0-102.5 5
 +
102.5-103
 +
103.0-103.5 i 1
 +
103.5-104 2
 +
 +
 +
 +
Pulae
 +
 +
 +
No. of
 +
patienta
 +
 +
 +
Pulie
 +
 +
 +
No. of
 +
patienta
 +
 +
 +
Pulae
 +
 +
 +
No. of
 +
patients
 +
 +
 +
60-70
 +
70-80
 +
80-90
 +
90-100
 +
100-110
 +
 +
 +
4
 +
 +
9
 +
 +
46
 +
 +
 +
110-120
 +
120-130
 +
130-140
 +
140-l.iO
 +
 +
 +
16
 +
21
 +
7
 +
5
 +
 +
 +
150-160
 +
160-170 2
 +
170-180 1
 +
Could not be 1
 +
counted
 +
 +
 +
 +
pre-operative diagnosis
 +
The pre-operativc diagnosis wa.s recorded on the history in
 +
212 cases. The correct diagnosis was made on admission in
 +
!)8 cases (4G<) and confirmed on examination after the patients had l)een anu'sthetized for oi)erntion. Twelve additional ca.«es were diagnosed correctly oidy after the patients
 +
were under ana-sthesia, while a probable diagnosis of extrauterine pregnancy was made in five other ca.ses, one of whicii
 +
had a jwsterior vaginal coeliotomy performed before the
 +
laparotomy for confirmation of the diagnosis. In 28 othc
 +
i-ases the condition was suspected but not definitely diagnosc(l
 +
until some operative procedure had been performed. In <>!•
 +
ca.^es (•iS'i) the extrauterine pregnancy was not diagnosed,
 +
although in a number of these cases some other pathologiciil
 +
condition pre.«ent was diagnosed correctly. The diagnfiscs
 +
recorded were made by some member of the resident staff in
 +
the large majority of the ca.«es.
 +
 +
Table of Diaonosfs Before Opkratiox
 +
Extraulprinp pregnancy (on admission examination I . . . . 98 cases
 +
Extrauterine pregnancy (on examination under aniesthesis 12 cases
 +
 +
 +
 +
Extrauterine pregnancy (probable diagnosis)
 +
 +
Extrauterine pregnancy (after exploratory puncture) ....
 +
 +
Retained membranes of extrauterine pregnancy
 +
 +
Pelvic abscess or extrauterine pregnancy
 +
 +
Chronic pelvic inflammatory disease or extrauterine pregnancy
 +
 +
Appendix abscess or extrauterine pregnancy
 +
 +
Chronic appendicitis or extrauterine pregnancy
 +
 +
Cystoma of ovary or extrauterine pregnancy
 +
 +
Myoma uteri or extrauterine pregnancy
 +
 +
Calcified myoma or lithopedion
 +
 +
Flbro-cystoma
 +
 +
Ovarian cyst with twisted pedicle
 +
 +
Multilocular cystic ovary
 +
 +
Ovarian tumor
 +
 +
Ovarian tumor ( malignant )
 +
 +
Papillomatous cyst of ovary
 +
 +
Parovarian cyst
 +
 +
Myomata uteri
 +
 +
Myomata uteri with pregnancy
 +
 +
Myomata uteri, cystic, or sarcoma of uterus
 +
 +
Myomata uteri, cystic, or angioma of uterus
 +
 +
Myomata uteri with adherent dermoid cyst
 +
 +
Pelvic abscess
 +
 +
Pelvic abscess with general peritonitis
 +
 +
Pelvic abscess or appendix abscess
 +
 +
Chronic pelvic inflammatory disease
 +
 +
Subacute pelvic inflammatory disease
 +
 +
Acute pelvic inflammatory disease
 +
 +
Chronic appendicitis
 +
 +
General peritonitis
 +
 +
Retained membranes
 +
 +
Abortion, infected
 +
 +
Miscarriage due to retroposition of the uterus
 +
 +
Pregnancy
 +
 +
Retroposition of the uterus
 +
 +
Chronic pelvic inflammatory disease..
 +
 +
Tubo-ovarian abscess
 +
 +
Ovarian cyst
 +
 +
Submucous myoma, cystic
 +
 +
Ovarian tumor
 +
 +
Extrauterine pregnancy
 +
 +
Chronic pelvic inflammatory disease. .
 +
 +
Papillocystoma of ovaries "
 +
 +
Tuberculous pelvic inflammatory disease
 +
 +
Pelvic inflammatory disease with ovarian cyst. .
 +
" No diagnosis made "
 +
 +
 +
 +
4 cases
 +
1 case
 +
 +
11 cases
 +
6 cases
 +
 +
<! cases
 +
1 case
 +
1 case
 +
1 case
 +
1 case
 +
1 case
 +
1 case
 +
1 case
 +
1 case
 +
1 case
 +
1 case
 +
1 case
 +
 +
1 case
 +
 +
5 cases
 +
 +
2 cases
 +
1 case
 +
 +
1 case
 +
 +
1 case
 +
 +
11 cases
 +
 +
1 case
 +
 +
1 case
 +
20 cases
 +
 +
2 cases
 +
 +
1 case
 +
 +
2 cases
 +
 +
1 case
 +
 +
2 cases
 +
1 case
 +
1 case
 +
 +
1 case
 +
 +
2 cases
 +
 +
1 case
 +
 +
 +
 +
1 case
 +
:! cases
 +
 +
 +
 +
We do not believe that the Hat-footed diagnosis of extrauterine pregnancy is as simple as many writers consider it.
 +
Ill making an estimate of the percentage of faulty dingiio.^es,
 +
we should al.<o include those cases diagno.'Jed as extrauterine
 +
pregnancy which, at operation, prove to be another condition.
 +
Ill this clinic the latter class of cases is nunierous. In jirivate jiractice among more intelligent patients, there sliould
 +
be a higher percentage of correct diagnoses made than in a
 +
free clinic. The classical case of an acute ruptured ectopic
 +
pregnancy is usually clear if a .satisfactory history can be olitained, but there are a great many cases in which the history
 +
points equally well to jielvic inflammatory disea.se. The latter
 +
ili.sease also gives .symptoms that not infrequently strongly
 +
suggest extrauterine pregnancy. Cases with unilateral intlammatory di.-^ea.se are .«een in this clinic fully as often as
 +
extrauterine pregnancies and may be very puzzling. Thi'
 +
 +
 +
 +
differential diagnosis in this class of cases is often difficult
 +
even when a careful history has been taken.
 +
 +
Very often there are other conditions present that make a
 +
positive diagnosis practically impossible. Another stumblingblock is encountered occasionally in patients who have had an
 +
early abortion with retained membranes and have a cystic
 +
ovary on one side. We have seen three cases of this cliaracter
 +
which were correctly diagnosed by one or more members of
 +
the staff, but which were considered to be unruptured extrauterine pregnancies by other members who examined the
 +
patients under equally favorable circumstances.
 +
 +
There are occasional cases in which the diagnosis is in
 +
doubt even after operation has been performed, as in the
 +
following :
 +
 +
Gyn. No. 22180. The patient was a white woman, age 33 ;
 +
she was admitted to the hospital May 16, 191G, complaining
 +
of "bowel trouble."
 +
 +
Married 18 years; three children, youngest six years of
 +
age. No miscarriages. Labors normal. Fever for two
 +
weeks beginning in the fourth week following the first labor ;
 +
otherwise the puerperia were normal.
 +
 +
Last menstrual period February. 1916; last preceding
 +
October, 1915. Miscarriage on January 1, 1916, after slight
 +
vaginal bleeding for the preceding week. A curettage was
 +
done by her family physician January 2 and the patient
 +
was told that " the afterbirth was perfect." No foetus was
 +
seen. A period normal, except slightly prolonged, began
 +
on February 7 and lasted seven days. On February 21 an
 +
appendectomy and a curettage were performed. The surgeon
 +
who operated said that the uterus, tubes and ovaries were
 +
normal at that time. No pain followed the operation until
 +
April 6, when she had a gradually increasing pain in the
 +
lower abdomen and back. This became quite severe, but
 +
lasted only one day. The abdomen felt sore for the following
 +
three days. She had no further abdominal pain until May
 +
13 at 6 p. m., when she began to have pain in the left lower
 +
quadrant of the abdomen, similar to the previous attack.
 +
There had been slight vaginal bleeding for three days prior
 +
to this attack, during which the bleeding increased considerably. This attack of pain lasted 36 hours.
 +
 +
P. .E.— Pulse 100. Temperature 99.6°, May 15, 1916.
 +
W. B. C, 19,000. Hbg. 95;?;.
 +
 +
Abdominal tenderness marked in the left lower quadrant
 +
and less marked in the right lower quadrant. ^Moderate
 +
rigidity below the umbilicus. A firm, smooth mass can be
 +
felt about half way between the umbilicus and pubis.
 +
 +
Pelvic Examination. — A bloody vaginal discharge is present. Cervix slightly softened and slightly enlarged. The
 +
tumor described above seems to be the uterus. A moderately firm mass, which is tender, can be felt in the left fornix.
 +
Blood clot crepitus in the cul-de-sac.
 +
 +
Diagnosis. — Extrauterine pregnancy, left, probablv witli
 +
beginning tubal abortion.
 +
 +
February 17, 1916. — Operation. A pelvic puncture was
 +
performed and about three ounces of old black blood was
 +
evacuated from the pelvis. The patient was immediatelv
 +
 +
 +
 +
prepared for laparotomy. There was a considerable amount
 +
of old blood in the abdomen. The tubes were found densely
 +
adherent in the cul-de-sac, the fimbriated ends were open,
 +
both tubes were considerably enlarged and oedematous. No
 +
foetal or placental tissue could be found, nor was there any
 +
visible site of an ectopic pregnancy in either tube. The tubes
 +
were released from adhesions and a cigarette drain placed
 +
through the cul-de-sac. There was a good deal of fresh
 +
bleeding during the operation. The patient was discharged
 +
June 16 after a rather prolonged convalescence. At the time
 +
of discharge the uterus was still enlarged, but there were no
 +
pelvic masses or tenderness.
 +
 +
TREATMENT
 +
The treatment of our cases has been operative, either by
 +
the abdominal or vaginal routes. In several cases posterior
 +
vaginal coeliotomy has been performed for diagnosis. Pelvic
 +
puncture has been employed for pelvic hematocele in a number of cases, although in 60^ of these cases a laparotomy was
 +
performed immediately afterwards.
 +
 +
Table of Operatioxs
 +
 +
Vaginal (only ) 24 cases (S%)
 +
 +
Pelvic puncture (only) 16 cases
 +
 +
Pelvic puncture with laparotomy (for hemorrhage
 +
 +
following puncture, 4 ) 24 cases
 +
 +
Pelvic puncture with dilatation and curettage. ... 3 cases
 +
 +
Dilatation and curettage with laparotomy 5 cases
 +
 +
Vaginal salpingectomy 1 case
 +
 +
Exploratory above Poupart's ligament into sac ... 3 cases
 +
Laparotomy 279 cases (92%)
 +
 +
Abdominal incision of sac with drainage 5 cases
 +
 +
Removal of fcetus and placenta 6 cases
 +
 +
Salpingectomy (unilateral) 180 cases
 +
 +
Salpingectomy (bilateral ) 56 cases
 +
 +
Resection of one tube 1 case
 +
 +
Puncture of hematosalpinx 2 cases
 +
 +
Total extirpation of sac and CONTENTSs. 12 cases
 +
 +
Partial extirpation of sac 1 case
 +
 +
Oophorectomy (unilateral) 108 cases
 +
 +
Oophorectomy (bilateral) 24 cases
 +
 +
Resection of one ovary 11 cases
 +
 +
Ovarian cyst tapped 1 case
 +
 +
Hysterectomy 30 cases
 +
 +
Resection of uterine cornu 7 cases
 +
 +
Myomectomy 5 cases
 +
 +
Excision of accessory tube 1 case
 +
 +
Ligation of remaining tube 1 case
 +
 +
Excision of abscess sac 1 case
 +
 +
Suspension of uterus 10 cases
 +
 +
Excision of mesenteric cyst 1 case
 +
 +
Excision of umbilical hernia 1 case
 +
 +
Resection of omentum 1 case
 +
 +
Release of intestinal adhesions 5 cases
 +
 +
Suture of rectum 3 cases
 +
 +
Suture of sigmoid 1 case
 +
 +
Resection of ileum 3 cases
 +
 +
Lateral anastomosis 3 cases
 +
 +
Additional: Perineal repair G cases
 +
 +
Additional: Perineal repair with suture of rectal sphincter 2 cases
 +
 +
 +
 +
 +
 +
Laparotomy by tlie abdoniiual rout4j has beeu preferred in
 +
all cases except those in which there was a pelvic hematocele
 +
with symptoms and signs indicating infection. In such
 +
cases, pelvic puncture and drainage is usually a safer procedure, althougii a secondary laparotomy may be necessarj'
 +
later for continued pain.
 +
 +
The majority of our patients have entered the hospital
 +
after examination in the Out-Patient Department and have
 +
l)een operated upon on the day following admission, unless
 +
they were in serious condition at the time of admission, when
 +
immediate operation has been performed, with very satisfactory results. One patient whose case has been previously reported by Richardson ( JoHxs Hopkins Hospital Bulletin )
 +
was in very extreme shock when admitted to the hospital and
 +
was treated expectantly. However, three days later, operation
 +
became imperative on account of marked abdominal distention and she died on the third day after the operation.
 +
Richardson thought this patient could have been operated
 +
upon the day following admission, when she had recovered
 +
somewhat from the primary shock and before serious distention had set in.
 +
 +
Whenever other pathological conditions demanding operation were present, they were included in the operative treatment, when the patient's condition justified a prolongation
 +
of the procedure.
 +
 +
Peritoneal Toilet. — In the majority of our cases the
 +
peritoneal cavity had been cleaned of blood and clot as well
 +
as possible. In 259 cases the peritoneal cavity was cleaned
 +
of blood and clot, and in eight cases no attempt was made to
 +
evacuate blood. We believe that the convalescence is more
 +
satisfactory when the blood is carefully removed.
 +
 +
Irrigation. — The peritoneal cavity was irrigated in 3^
 +
cases, sterile normal salt solution being used in 35 ca.ses and
 +
sterile water in two cases. In recent years this practice has
 +
been discontinued.
 +
 +
The sac ha.s been irrigated following pelvic puncture in
 +
nine cases, but this procedure has been abandoned on
 +
account of the danger of breaking through the wall and filling the peritoneal cavity with the fluid, as occurred in one
 +
case and resulted in a general peritonitis. This patient recovered after a secondary operation for drainage of the
 +
abdomen.
 +
 +
Drainage. — Primary drainage has been used in 150 ca.«t
 +
glass tubes were employed twice and in the remainder gaui /
 +
usually in the form of a cigarette drain. The drains arc
 +
l)referably placed through the cul-de-sac into the vagina,
 +
rather than through the abdominal wall (38 cases were
 +
drained through the abdominal incision). At the present
 +
time drains are not employed unless there is .some evidence
 +
iif infection in the pelvis or a general ooze following the
 +
release of adhesions.
 +
 +
Stimulant.^. — Salt solution administered subcutancously \y
 +
depended upon for stimulation during operation and halieen employed in 5fi cases. Salt solution by rectum has been
 +
used in 13 cases and with equal parts of coffee in four rase.-.
 +
The peritoneal cavity was filled with salt solution In'fore
 +
 +
 +
 +
(losing the abdomen in 34 cases, but this procedure has been
 +
discontinued, as it seems to favor post-operative distention and
 +
generally increases the patient's discomfort, as well as spreading infection over the entire abdomen, if any should be present.
 +
In the case of one patient with very serious shock, an infusion
 +
of normal .^alt .solution was administered through the radial
 +
artery and resulted in gangrene of the hand. In a few cases
 +
drug stimulants have been used hypodemiically, strychnine
 +
in 16 cases, digitalis in three cases and brandy and ether in
 +
one case.
 +
 +
Transfusion of blood has not been used in any case included
 +
in this series. Very satisfactory results, however, have been
 +
reported by others who have used both direct and indirect
 +
transfusion, but sometimes there is no time to match the
 +
bloods of donor and recipient and a severe reaction following
 +
the transfusion may be fatal. The majority of these acutely
 +
ruptured cases can be stimulated sufliciently with subcutaneous infusions of large quantities of salt solution to tide them
 +
over the immediate shock. As all the.se patients are of ages
 +
most favorable for operative risk and as a rule have been in
 +
good health prior to the acute onset, they usually will recover
 +
if stimulated with salt solution for the first few hours.
 +
 +
Lichtenstein (Muench. Med. Wchnschr., 1915. LXII,
 +
1597) reports eight cases treated by reinjection of the blood
 +
found in the patient's abdomen after defibrination and dilution with salt solution 3:2, a procedure open to criticism.
 +
 +
The intravenous injection of 7^ acacia in distilled water,
 +
filtered and sterilized by boiling, will probably prove to be
 +
of great value in those cases in which there is severe shock due
 +
to great loss of blood volume (Rous-Wilson, Jour. Am. Med.
 +
Assn., January 26, 1918). We have used this preparation in
 +
one case in which there was an abundant hemorrhage at operation and severe shock, with gratifying results.
 +
 +
There are, of course, patients in such serious shock when
 +
first seen that operation is contra-indicated. In these cases
 +
shock must be combated by some of the methods mentioned
 +
above, but as soon as the patient is in condition to stand operation, it should not be delayed.
 +
 +
The time consumed in operating is shown in the table for
 +
255 cases.
 +
 +
 +
 +
Table Siiowixo the Dr
 +
 +
 +
RATION ay
 +
 +
 +
OrERATIONS
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
Number
 +
 +
 +
 +
 +
Number
 +
 +
 +
Timt
 +
 +
 +
of
 +
 +
 +
Time
 +
 +
 +
ol
 +
 +
 +
Time
 +
 +
 +
ol
 +
 +
 +
 +
 +
cues
 +
 +
 +
 +
 +
C*Mt
 +
 +
 +
 +
 +
cue*
 +
 +
 +
mi».
 +
 +
 +
 +
 +
An. Mill.
 +
 +
 +
 +
 +
krf. ndi.
 +
 +
 +
 +
 +
S
 +
 +
 +
3
 +
 +
 +
45
 +
 +
 +
22
 +
 +
 +
1 25
 +
 +
 +
4
 +
 +
 +
10
 +
 +
 +
6
 +
 +
 +
60
 +
 +
 +
23
 +
 +
 +
1 30
 +
 +
 +
4
 +
 +
 +
16
 +
 +
 +
4
 +
 +
 +
55
 +
 +
 +
14
 +
 +
 +
1 40
 +
 +
 +
2
 +
 +
 +
20
 +
 +
 +
10
 +
 +
 +
 +
 +
21
 +
 +
 +
1 45
 +
 +
 +
4
 +
 +
 +
26
 +
 +
 +
14
 +
 +
 +
1 6
 +
 +
 +
11
 +
 +
 +
1 SO
 +
 +
 +
2
 +
 +
 +
30
 +
 +
 +
21
 +
 +
 +
1 10
 +
 +
 +
17
 +
 +
 +
1 65
 +
 +
 +
2
 +
 +
 +
35
 +
 +
 +
29
 +
 +
 +
1 16
 +
 +
 +
 +
 +
 +
2
 +
 +
 +
2
 +
 +
 +
40
 +
 +
 +
23
 +
 +
 +
1 20
 +
 +
 +
8
 +
 +
 +
2 10
 +
2 26
 +
 +
 +
2
 +
 +
1
 +
 +
 +
 +
Total, 256 operations.
 +
 +
 +
 +
All operations consuming less than 20 minutes were pelvic
 +
punctures only.
 +
 +
 +
 +
22
 +
 +
 +
[No. 33.
 +
 +
 +
Thirty operators performed 267 operations.
 +
 +
One operator performed 44 operations
 +
 +
One operator performed 35 operations
 +
 +
One operator performed 27 operations
 +
 +
One operator performed 21 operations
 +
 +
One operator performed 15 operations
 +
 +
Two operators performed 14 operations (each)
 +
 +
One operator performed 12 operations
 +
 +
One operator performed 11 operations
 +
 +
One operator performed 10 operations
 +
 +
One operator performed 9 operations
 +
 +
One operator performed 8 operations
 +
 +
Two operators performed 6 operations (eacli)
 +
 +
One operator performed 5 operations
 +
 +
Four operators performed 4 operations ( each )
 +
 +
One operator performed 3 operations
 +
 +
Six operators performed 2 operations (each)
 +
 +
Four operators performed 1 operation ( eacli )
 +
 +
Ancesthesia. — Iii the large majority of these cases, nitrous
 +
oxide followed by ether, administered by tiie open drop
 +
method, lias been used. Some patients have been given chloroform or ether only, and a few chloroform and ether.
 +
 +
Diagnosis at Operation
 +
 +
Ruptured with free blood in peritoneal cavity 100 -, .„^ .
 +
 +
Ruptured with encapsulated blood in peritoneal cavity 66 r
 +
Tubal abortion with free blood in peritoneal cavity ... 381
 +
Tubal abortion with encapsulated blood in peritoneal I (19%)
 +
 +
cavity 13 J
 +
 +
Unruptured , 55 (20%)
 +
 +
Total 272
 +
 +
Interstitial pregnancy, right 2 '
 +
 +
Tubal pregnancy, right 135
 +
 +
Tubal pregnancy, left 131
 +
 +
Ovarian pregnancy, right 2 '
 +
 +
 +
 +
Total 270
 +
 +
' Wynne, J. H. H. Bull. XXIX, No. 324, February. 1918.
 +
- CuUen & McAll. Surg., Gyn. & Obst.. 1912; M.ver & Wynne, to be
 +
reported.
 +
 +
Advanced Extrauterine Pregnancy
 +
 +
 +
 +
In one case the pregnant tube was ruptured during the
 +
examination under ether. Active hemorrhage at time of operation occurred in 20 cases.
 +
 +
The peritoneum was noted as blood stained before bcinu
 +
opened in 43 cases.
 +
 +
The blood in the peritoneal cavity was designated as fluid
 +
in 66, clotted in 24 (infected, three) ; there were fluid and
 +
clots in 55 cases.
 +
 +
The opposite tube was noted to be normal in 15 cases.
 +
 +
The opposite ovary was noted to be normal in 12 case.s.
 +
 +
The appendix was described as normal in 31 cases.
 +
 +
The appendix was involved in the sac in 11 cases.
 +
 +
The appendix was adherent to a myoma in one case.
 +
 +
A CASE OF PREGNANCY IN A RUDIMENTARY HORN
 +
Gyn. No. 16T27. The patient was a white woman, age 30,
 +
admitted to the hospital June 9, 1910, complaining of vaginal
 +
l)leeding and pain the left .side of the abdomen. Married five
 +
vears; one child two years old. One miscarriage at two
 +
months, one year ago. Labor and puerperia normal. Last
 +
menstrual period January, 1910.
 +
 +
P. I. — The patient considered herself pregnant, but noticed
 +
that the uterus had not enlarged as rapidly as during her
 +
former pregnancy and that the enlargement was more on the
 +
left side than on the right. For a month she has noticed
 +
tenderness over the left side of the abdomen. At 6 a. m. on
 +
the morning of admission, she was awakened by pains in the
 +
pelvis, similar to labor pains and shortly after, passed blood
 +
and bits of tissue resembling placenta. There was slight
 +
bleeding afterwards, but the pain subsided. She was nauseated this morning.
 +
 +
Phi/gical Examination Under Ether. — On abdominal examination, a mass can be felt in the lower abdomen, which
 +
is rather soft and boggy and about the size of a large orange.
 +
The mass is movable and seems to be attached to the uterus.
 +
 +
 +
 +
Gyn. No.
 +
 +
 +
Race
 +
 +
 +
Age of
 +
patient
 +
 +
 +
Date
 +
 +
 +
Fre-operative
 +
diagnosis
 +
 +
 +
Operation
 +
 +
 +
Placenta
 +
 +
 +
Result
 +
 +
 +
Feetus
 +
 +
 +
 +
 +
 +
 +
Years 114
 +
 +
 +
B.
 +
 +
 +
29
 +
 +
 +
1890
 +
 +
 +
Fibrocystoma.
 +
 +
 +
Laparotomy.
 +
 +
 +
Removed.
 +
 +
 +
Died. Shock.
 +
 +
 +
Dead. Male. Length 53 cm.
 +
 +
 +
101
 +
 +
 +
B.
 +
 +
 +
28
 +
 +
 +
1890
 +
 +
 +
Abdominal pregnavicy
 +
(several mos. past term) .
 +
 +
 +
Lai "•^'tomv
 +
 +
Removed.
 +
 +
 +
Recovery.
 +
 +
 +
Wt. 2800 grms. Male. Dead.
 +
Fully developed. Crown
 +
rump 30 cm.
 +
 +
 +
1,705
 +
 +
 +
W.
 +
 +
 +
42
 +
 +
 +
1893
 +
 +
 +
Ectopic, two months past
 +
term.
 +
 +
 +
Lapatpitomy.
 +
 +
 +
Removed.
 +
 +
 +
Died. General
 +
peritonitis.
 +
 +
 +
Dead. Length. 42 cm.: wt.,
 +
4 lbs.
 +
 +
 +
4,564
 +
 +
 +
B.
 +
 +
 +
45
 +
 +
 +
1896
 +
 +
 +
Calcified myoma or litliopedion four years past
 +
term.
 +
 +
 +
Laparotomy.
 +
(Reported by
 +
 +
 +
Removed.
 +
J. G.Clark).
 +
 +
 +
Recovery.
 +
 +
 +
Lithopedion. Weight, 43 lbs.
 +
 +
 +
7,182
 +
 +
 +
W.
 +
 +
 +
34
 +
 +
 +
1899
 +
 +
 +
M u 1 1 i 1 c u 1 a r cystoma
 +
 +
ovarii.
 +
Ruptured tubal pregnancy,
 +
 +
 +
Laparotomy.
 +
 +
 +
Removed.
 +
 +
 +
Recovery.
 +
 +
 +
Dead. Length, 25 cm.
 +
 +
 +
12.207
 +
 +
 +
W.
 +
 +
 +
41
 +
 +
 +
1905
 +
 +
 +
Laparotomy.
 +
 +
 +
Removed.
 +
 +
 +
Recovery.
 +
 +
 +
Macerated. Weight, 12.')0
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
two months past term.
 +
 +
 +
 +
 +
 +
 +
 +
 +
grms. Dead.
 +
 +
 +
13.272
 +
 +
 +
B.
 +
 +
 +
28
 +
 +
 +
1906
 +
 +
 +
 +
 +
Laparotomy.
 +
Laparotomv.
 +
 +
 +
 +
 +
Recovery.
 +
Recovery,
 +
 +
 +
Full term, female. Living.
 +
Six months. 33 cm. long.
 +
 +
 +
13,546
 +
 +
 +
W.
 +
 +
 +
35
 +
 +
 +
1907
 +
 +
 +
Extrauterine pregnancy.
 +
 +
 +
Removed.
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
ruptured.
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
13.673
 +
 +
 +
B.
 +
 +
 +
30
 +
 +
 +
1907
 +
 +
 +
 +
 +
Laparotomy.
 +
Laparotomy.
 +
 +
 +
 +
 +
Recovery.
 +
Recovery.
 +
 +
 +
 +
 +
13,806
 +
 +
 +
B.
 +
 +
 +
33
 +
 +
 +
1907
 +
 +
 +
Abdominal pregnancy.
 +
 +
 +
Removed.
 +
 +
 +
Macerated remains of foetus.
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
(Reported by CuUen,
 +
 +
 +
Surg., Gvn. cS:
 +
 +
 +
b.st., 1915, X
 +
 +
 +
X, 261.)
 +
 +
 +
 +
 +
17,056
 +
 +
 +
W.
 +
 +
 +
35
 +
 +
 +
1911
 +
 +
 +
 +
 +
Laparotomy.
 +
 +
 +
Removed.
 +
 +
 +
Recovery.
 +
 +
 +
Dead. Intraligamentary, rt.
 +
Weight, 6A lbs.
 +
 +
 +
19,092
 +
 +
 +
B.
 +
 +
 +
22
 +
 +
 +
1913
 +
 +
 +
Extrauterine pregnancy,
 +
infected.
 +
 +
 +
Laparotomy.
 +
 +
 +
Removed.
 +
 +
 +
Died. General
 +
peritonitis.
 +
 +
 +
Macerated. Femur, 5.2 cm.
 +
Humerus, 4.8 cm.
 +
 +
 +
21,494
 +
 +
 +
B.
 +
 +
 +
29
 +
 +
 +
1915
 +
 +
 +
Ovarian tumor, right.
 +
 +
 +
Laparotomy.
 +
 +
 +
Removed.
 +
 +
 +
Recovery.
 +
 +
 +
Dead. Weight, 1911 grms.
 +
44.5 cm.
 +
 +
 +
 +
Januabt, 1919]
 +
 +
 +
23
 +
 +
 +
 +
Pelvic Examination. — The vagina and cervix are normal.
 +
The fundus of the uterus is soft and boggy and, attached to
 +
it by a pedicle, is the mass described above.
 +
 +
Pre-Operative Diagnosis. — Extrauterine pregnancy or
 +
pregnancy in a rudimentary liorn.
 +
 +
Operation. — The mass was found to be a pregnancy in thi;
 +
rudimeutarj' left horn of a bicornat* uterus and was attached
 +
to the right side of the uterus by a small pedicle. The left
 +
tube was stretched over the pregnant horn and togetlier with
 +
the left ovary was so intimately associated with it as to necessitate their removal. The left horn was amputated close to
 +
the right side and there remained a practically normal uterus.
 +
 +
The patient was discharged on the 13th day after an uncomplicated convalescence.
 +
 +
Diagnosis. — Pregnancy in a rudimentary horn, left.
 +
 +
Pathological Xo. 15,150. — The specimen has been opened
 +
anteriorly in the operating-room and measures 7x8x5 centimeters. The walls measure 1.5 centimeter in thickness.
 +
Foetus of 4 to 5 months in unruptured membranes.
 +
 +
 +
 +
Patholooicai, Retobts
 +
 +
The tissues removed at operation have been studied histologically and the diagnosis has been verified. We are unable
 +
at the present time to give a thorough report on this interesting side of the disease.
 +
 +
The routine preparations, where the endometrium was examined, have been reported as follows:
 +
 +
Normal endometrium 13
 +
 +
Gland hypertrophy of the endometrium 5
 +
 +
Endometritis, chronic 5
 +
 +
Endometritis, acute 1
 +
 +
Decidual reaction of the endometrium 7
 +
 +
Cast of uterine cavity with decidual reaction 2
 +
 +
In addition to ectopic pregnancy the following diagnoses
 +
were made at or before operation :
 +
 +
Atrophy of the opposite tube 1
 +
 +
Hematosalpinx of the opposite tube 3
 +
 +
Hydrosalpinx of the opposite tube 16
 +
 +
Chronic salpingitis of the opposite tube 8
 +
 +
Pyosalplnx of the opposite tube 6
 +
 +
Tuboovarian abscess of opposite tube 1
 +
 +
Ovarian abscess •. 3
 +
 +
Chronic pelvic inflammatory disease 92
 +
 +
Cystic ovaries 13
 +
 +
Ovarian cyst, follicular 9
 +
 +
Ovarian cyst, corpus luteum 3
 +
 +
Parovarian cyst 1
 +
 +
Retroposition of the uterus 6
 +
 +
.Myomata uteri 17
 +
 +
.Membranous dysmenorrhoea 1
 +
 +
Mesenteric cyst 1
 +
 +
General peritonitis 1
 +
 +
Pre-operative rupture of abscess Into rectum 1
 +
 +
Post-operative adhesions 1
 +
 +
Bladder adhesions 1
 +
 +
Omental adhesions 14
 +
 +
Intestinal adhesions 19
 +
 +
Meckel's diverticulum 1
 +
 +
 +
 +
Umbilical hernia
 +
 +
 +
2
 +
 +
 +
Appendicitis, chronic
 +
 +
 +
52
 +
 +
 +
Appendicitis, sub-acute
 +
 +
 +
5
 +
 +
 +
Appendicitis, acute
 +
 +
 +
2
 +
 +
 +
Periappendicitis
 +
 +
 +
7
 +
 +
 +
Complications before operation :
 +
Pulmonary tuberculosis
 +
 +
 +
2
 +
 +
 +
Diabetes i
 +
 +
 +
Insanity i
 +
 +
 +
Arthritis deformans i
 +
 +
 +
Chronic nephritis i
 +
 +
 +
Ascaris lumbricoides i
 +
 +
 +
Uncinaria Americana l
 +
 +
 +
 +
Post-operative Compucatioxs
 +
 +
The complications following operations have been as follows:
 +
 +
Acute bronchitis 2 cases with recovery.
 +
 +
Bronchopneumonia 2 cases with recovery.
 +
 +
Lobar pneumonia 2 cases with 1 death.
 +
 +
Fecal fistula, abdominal 2 cases with 1 death ")
 +
 +
Fecal fistula, vaginal 1 case with death. . . ll patient.
 +
 +
Urinary fistula, abdominal 1 case with death. . . J
 +
 +
Atonic ileus 1 case with recovery.
 +
 +
Peritonitis, general G cases with 5 deaths.
 +
 +
Infected drainage cavity with
 +
 +
collection of pus 3 cases with recovery.
 +
 +
Cystitis 2 cases.
 +
 +
Phlebitis (of left leg) 3 cases.
 +
 +
Tetanus 1 case with recovery.
 +
 +
(Reported by Casler at Southern Medical Association meeting
 +
in 1917.)
 +
 +
Gangrene of the hand following
 +
intraarterial (radial) salt infusion 1 case.
 +
 +
Mastitis, right 1 case.
 +
 +
Acute follicular tonsillitis 1 case.
 +
 +
Influenza 1 case.
 +
 +
Erysipelas (facial) 1 case.
 +
 +
Shock and antcmia have been omitted from this list, as
 +
accurate data for all cases are not available.
 +
 +
 +
 +
SuBSEQfE.XT Operations for Co.mplicatio.vs Abisino erom the
 +
Prim.\by Operatiom
 +
 +
Gyn. No. 2,612. Abdominal drainage for peritonitis following
 +
rupture of sac by Irrigation after pelvic puncture. Symptoms of peritonitis 11 days after
 +
operation. Recovery.
 +
 +
Gyn. No. 7,901. Exploratory laparotomy for localized poritonitta
 +
36 hours after left salpingo-oophorectomy and
 +
vaginal drainage. Death on the sixth day from
 +
lobar pneumonia.
 +
 +
Gyn. No. 11,473. Pelvic puncture for drainage, 23 days after salpingo-oophorectomy. Recovery.
 +
 +
Gyn. No. 11,491. Dilatation of drainage tract and evacuation of
 +
pus 10 days after pelvic puncture. Recovery.
 +
 +
Gyn. No. 12,380. Rupture of abdominal incision 22 days after laparotomy. Recovery.
 +
 +
Gyn. No. 15,529. Right salpingo-oophorectomy and release of adhesions 1.J days after pelvic puncture and
 +
drainage of infected hematocele. Recovery.
 +
 +
 +
 +
34
 +
 +
 +
[No. 335
 +
 +
 +
 +
Gyn.No. 17,251.
 +
 +
 +
 +
January 16, 1911, at the first operation, during
 +
hysterectomy, left salpingo-oophorectomy and
 +
release of adhesions, the rectum was torn.
 +
Abdominal fecal fistulae resulted.
 +
 +
April 29, 1911. Excision of- fistulous tracts, suture of rectum and bladder. Appendectomy.
 +
Failure.
 +
 +
September 18, 1911. The patient was readmitted
 +
to the hospital (Gyn. No. 17,804) for abdominal fecal fistula and a recto-vaginal fistula following her first operation.
 +
 +
September 30, 1911. Excision of abdominal fistula, resection of sigmoid, end-to-end anastomosis, suture of bladder. Shock.
 +
 +
October 5, 1911. Enterostomy for ileus.
 +
 +
October 6, 1911. Enterostomy for ileus. Death
 +
on the table.
 +
 +
 +
 +
CAUSE OP DEATH
 +
There have been 13 deaths in our scries of 303 cases and
 +
autopsies were performed on six of these.
 +
 +
Gyn.No. 114. (Autopsy No. 72.) Shock 12 hours after operation. This patient was in a very critical con
 +
 +
 +
dition when operated upon. No anatomical
 +
cause of death was found at autopsy.
 +
 +
Gyn.No. 521. (Autopsy No. 181.) Died 24 hours after operation. The anatomical diagnosis at autopsy
 +
was: Acute general peritonitis (pure culture
 +
B. coli from bloody peritoneal fluid), perforation of appendix with circumscribed abscess.
 +
 +
Gyn.No. 1,795. (Autopsy No. 38S.) Died 10 days after operation. At autopsy an acute fibro-purulent
 +
peritonitis, chronic diffuse nephritis and gallstones were found.
 +
 +
Gyn.No. 7,901. (Autopsy No. 1562.) Death 6 days after operation, of lobar pneumonia.
 +
 +
Gyn. No. 10,678. (No autopsy.) Death 3 days after operation.
 +
On admission the hemoglobin was 15 per cent
 +
and on the day of death 10 per cent.
 +
 +
Gyn. No. 12,042. (No autopsy.) Death 9 hours after operation.
 +
This patient was operated on by the vaginal
 +
route and a large amount of clot and fiuid
 +
blood evacuated, followed by a gush of bright
 +
red blood. Laparotomy was immediately performed. Shock.
 +
 +
 +
 +
Table Showing Pbegnancies Since Operation
 +
 +
 +
 +
Character of operatit
 +
 +
 +
 +
No. of years
 +
since operation
 +
 +
 +
 +
of ciiildren and miscarriages since operation
 +
 +
 +
 +
1,636
 +
 +
1,710
 +
 +
2,805
 +
 +
4,120
 +
 +
6,482
 +
 +
8,441
 +
 +
9,740
 +
 +
9,746
 +
 +
10,258
 +
 +
10,544
 +
 +
11,215
 +
 +
11,244
 +
 +
11,592
 +
 +
11,830
 +
 +
11,834
 +
 +
12,236
 +
 +
12,268
 +
12,398
 +
14,167
 +
15,309
 +
 +
15,644
 +
 +
15,955
 +
17,428
 +
18,744
 +
 +
19,781
 +
20,777
 +
21,017
 +
21,082
 +
21,483
 +
22,303
 +
22,445
 +
 +
 +
 +
Incision of sac with drainage
 +
 +
Enucleation of sac
 +
 +
Right salpingo-oophorectomy
 +
 +
Pelvic puncture with drainage
 +
 +
Right salpingectomy
 +
 +
Right salpingo-oophorectomy
 +
 +
Left salpingectomy
 +
 +
Right salpingo-oophorectomy
 +
 +
Left salpingectomy
 +
 +
Left salpingectomy with resection of right ovary
 +
 +
Right salpingo-oophorectomy
 +
 +
Pelvic puncture and exploratory laparotomy
 +
 +
Right salpingectomy
 +
 +
Pelvic puncture •
 +
 +
Left salpingo-oophorectomy
 +
 +
Right salpingo-oophorectomy
 +
 +
Right salpingectomy
 +
 +
Right salpingo-oophorectomy
 +
 +
Left salpingo-oophorectomy and resection of right ovary. .
 +
Left salpingo-oophorectomy
 +
 +
Right salpingo-oophorectomy
 +
 +
Left salpingo-oophorectomy
 +
 +
Right salpingectomy
 +
 +
Right salpingectomy
 +
 +
Right salpingectomy
 +
 +
Resection of right cornu
 +
 +
Right salpingectomy, resection of right ovary, myomectomy
 +
 +
Right salpingectomy
 +
 +
Right salpingectomy
 +
 +
Right oophorectomy
 +
 +
Left salpingo-oophorectomy
 +
 +
 +
 +
23 months
 +
20 months
 +
 +
15 months
 +
 +
16 months
 +
 +
 +
 +
5 full-term children.
 +
2 full-term children.
 +
 +
1 full-term child.
 +
 +
2 full-term children.
 +
 +
1 miscarriage at 2% months 4 years after operation.
 +
 +
2 full-term children, 1 miscarriage.
 +
1 miscarriage.
 +
 +
5 miscarriages, the first 2 years after operation.
 +
 +
1 full-term child.
 +
 +
2 full-term children.
 +
2 full-term children.
 +
1 full-term child.
 +
 +
6 full-term children.
 +
 +
1 tubal pregnancy 8 years after operation.
 +
 +
1 full-term child.
 +
 +
2 miscarriages 10 and 8 years ago at 3 months;
 +
 +
1 full-term child 6 years ago.
 +
 +
1 miscarriage.
 +
 +
2 miscarriages.
 +
 +
1 full-term child.
 +
 +
1 full-term child 2 years after operation; 1 miscarriage 6 years after operation.
 +
 +
1 miscarriage and 1 full-term child 3 years after
 +
operation.
 +
 +
1 full-term child.
 +
 +
1 full-term child.
 +
 +
1 full-term child 14 months after operation; 1 fullterm child 32 months after operation.
 +
 +
8 months pregnant when heard from.
 +
 +
1 full-term child 1% years after operation.
 +
 +
1 full-term child 1 year after operation.
 +
 +
1 miscarriage (induced) 6 months after operation.
 +
 +
3 weeks from term when heard from.
 +
 +
1 full-term child IS months after operation.
 +
1 full-term child 11 months after operation.
 +
 +
 +
 +
F^VE Patients Opekated on fob Second Ectopic Pregnancy in This Clinic
 +
 +
 +
 +
Second operation
 +
 +
 +
 +
4,147
 +
 +
9,781
 +
 +
13,776
 +
 +
15,771
 +
 +
16,230
 +
 +
 +
 +
Pelvic puncture in 1896
 +
 +
Right salpingo-oophorectomy in 1902
 +
 +
Left salpingectomy in 1907
 +
 +
Right salpingectomy in May, 1909
 +
 +
Right salpingo-oophorectomy in November, 1909
 +
 +
 +
 +
Right salpingectomy in 1904
 +
 +
Left salpingo-oophorectomy in 1905
 +
 +
Right salpingectomy in 1908
 +
 +
Left salpingectomy in November, 1909
 +
 +
Hysterectomy; left salpingo-oophorectomy in January, 1911
 +
 +
 +
 +
11,590
 +
12,290
 +
14,895
 +
16,188
 +
 +
17,251
 +
 +
 +
 +
January, 1919]
 +
 +
 +
25
 +
 +
 +
 +
These six fatalities were reported in Kelly's Operative
 +
 +
Gynecology, Vol. II.
 +
 +
Gyn. No. 12,830%. (No autopsy.) Death 4 hours after operation.
 +
The patient was in serious shock when operated upon. About 2 liters of free blood were
 +
evacuated from the abdomen.
 +
 +
Gyn. No. 15,314. (No autopsy.) Death 3 days after operation
 +
from shock. (Reported by E. H. Richardson.)
 +
 +
Gyn. No. 17,119. (No autopsy.) Death 2\i hours after operation.
 +
The patient was in good condition after the
 +
operation until 3 minutes before death. Probably embolus.
 +
 +
Gyn. No. 17,211. (.\utopsy No. 3489.) Death 8 days after operation. Anatomical diagnosis at autopsy:
 +
Acute general peritonitis.
 +
 +
Gyn. No. 17,251. (No autopsy.) Death S days after secondary
 +
operation tor fistula following primary operation. General peritonitis.
 +
 +
Gyn. No. 18,731. (No autop.sy.) Death 2Vi hours after operation.
 +
Shock. This patient had diabetes.
 +
 +
Gyn. No. 19.092. (Autopsy No. 38S4.) Death 12 days after operation. .\t autopsy acute general peritonitis and
 +
embolic pneumonia were found. At operation
 +
the sac containing foetal bones and infected
 +
material was ruptured.
 +
 +
Immediate Resvlts
 +
 +
Well 271 (89.4%)
 +
 +
Improved 19 (6.3%)
 +
 +
Died 13 (4.3%)
 +
 +
Ultijiate Results
 +
Letters were sent to the 290 patients who recovered from
 +
the operations for ectopic pregnancy. Answers to the fol
 +
 +
 +
low-up letters were obtained from 118 patients and nine, who
 +
did not answer the letter, were later readmitted to this hospital. Of 120 patients, 100 have been well since operation,
 +
five have had poor health since operation, .seven report fair
 +
health and two no change in general health since operation.
 +
Four had good health for several months or years, and afterwards died, one of pulmonary tubenulosis, one of acute intestinal obstruction, one of post-operative pneumonia. In one
 +
ease the cause of death was not stated.
 +
 +
Of the series of 127 cases, there was no possiltility of future
 +
pregnancy in 33. Of the remaining 9G in whom there wa.s
 +
a possibility of future pregnancy 36 (38°) have since become
 +
pregnant one or more times; 61 pregnancies have resulted in
 +
•?7 full-term children ; two patients were pregnant almost at
 +
term when heard from. In 16 cases the pregnancy ended in
 +
miscarriages and six patients had a second extrauterine
 +
pregnane}'.
 +
 +
Opeuatioxs Subsequent to Operation fob Ectopic Pbeonaxct
 +
Post-operative ventral hernia has occurred in eight cases;
 +
four have been repaired in this hospital and one in another
 +
hospital, and three patients have not been submitted to another operation. One patient was operated upon for intestinal
 +
obstruction and one had a vaginal panhysterectomy performed in this hospital for carcinoma of the cervix.
 +
In all 14.5 patients have been followed on this point.
 +
 +
I wish to thank Dr. Howard A. Kelly for permission to
 +
publish this report.
 +
 +
 +
 +
NOTES AND NEWS
 +
 +
 +
 +
Dr. George Blumer is Chairman of the Medical Advisory Board,
 +
Yale University, New Haven, Conn.
 +
 +
Dr. Montague Boyd is Associate Professor of Surgery (Genitourinary), Emory University: Andrologist, Wesley Memorial Hospital and Visiting Genitourinary Surgeon, Grady Hospital, Atlanta, Ga. Government service: Captain. M. R. C, on duty in
 +
France.
 +
 +
Dr. Walter V. Brem is .Major .M. C, and Chief of the .Medical
 +
Service, U. S. Army Base Hospital, Camp Fremont, Cal.
 +
 +
Dr. Helen Smith Brown is Lecturer In Social Hygiene for the
 +
Commission on Training Camp .Activities, Washington. D. C.
 +
 +
Dr. S. W. Clausen is Instructor in Pediatrics, Washington University Medical School and Assistant Physician to the St. Louis
 +
Children's Hospital. He Is First Lieutenant, M. R. C, and is in
 +
active service.
 +
 +
Dr. Malvern B. Clopton is Major, M. R. C. He is a member
 +
of Washington University Hospital Unit No. 21, and is stationpd
 +
with General Hospital No. 12, B. E. F., Rouen, France.
 +
 +
Dr. Stanley Cobb is First Lieutenant. M. C, Division of Brain
 +
Surgery.
 +
 +
Dr. Sydney M. Cone Is Captain, M. R. C, and is stationed at the
 +
Alder Hey English Military Orthopedic Hospital. England.
 +
 +
Dr. Henry Wireman Cook is Associate Director of the Bureau of
 +
Medical Service, American Red Cross, Washington, D. C.
 +
 +
 +
 +
Dr. W. L. Cousins Is Surgeon-in-Chlcf of St. Barnabas Hospital,
 +
Portland, Me. Government service: Major, M. R. C, and Chief
 +
of the Surgical Staff U. S. Army Base Hospital, Camp Gordon, Ga.
 +
 +
Dr. J. Stalge Davis is Captain, M. C, U. S. Army, and is on active
 +
duty in Baltimore.
 +
 +
Dr. Ernest C. Dickson Is Associate Professor of Medicine, Iceland
 +
Stanford University School of Medicine. Government service:
 +
Captain, C. A. M. C, stationed In Basingstoke, England.
 +
 +
Dr. Richard N. Duffy Is Surgeon to the New Bern General Hospital, New Bern, N. C.
 +
 +
Dr. C. B. Dunn Is Chief of Staff, Southeastern Hospital for the
 +
Insane, Madison, Ind., and on the teaching staff King's Daughters
 +
Hospital, Madison, Ind.
 +
 +
Dr. Arthur B. Emmons Is Captain. M. R. C, and Is stationed In
 +
Evacuation Hospital No. 2, A. E. F., France.
 +
 +
Dr. W. L. Estes, Jr., la Director of St. Luke's Hospital, South
 +
Bethlehem, Pa. Government service: Captain, M. R. C, attached
 +
to Mobile Operating Unit No. 1. Section No. 1, A. E. F., France.
 +
 +
Dr. William W. Farr Is Captain, .Medical Corps, U. S. A., stationed
 +
at U. S. Base Hospital. Camp Shelby, Hattlesburg, Miss., with title
 +
of Chief of Subsection of Otolaryngology.
 +
 +
Dr. A. L. Fisher is Captain, M. C, and is In charge of the Surgical Service, U. S. Base Hospital No. 30, A. E. F.
 +
 +
 +
 +
26
 +
 +
 +
[No. 335
 +
 +
 +
 +
Dr. J. M. T. Finney is Brigadier General, M. C, U. S. Army, and is
 +
Surgical Consultant, A. E. F., France.
 +
 +
Dr. Simon Flexner is Lieutenant Colonel, Medical Corps, U. S. A.
 +
He is on duty at the Rockefeller War Demonstration Hospital,
 +
New York City.
 +
 +
Dr. James R. Garber is Instructor in Obstetrics South Highlands
 +
Infirmary Training School for Nurses, Visiting Obstetrician to the
 +
Hillman Hospital, Attending Obstetrician to the Salvation Army
 +
Home, Birmingham, Ala., and Acting Secretary of the Southern
 +
Medical Association.
 +
 +
Dr. S. McPheeters Glasgow is Captain, M. C, and is stationed
 +
at Camp Zachary Taylor, Ky.
 +
 +
Dr. L. W. Gorham is Captain, M. R. C, and is stationed with
 +
I\ S. Base Hospital No. 33, Portsmouth, England.
 +
 +
Dr. F. F. Gundrum is Vice-President, California State Board of
 +
Health, and Consulting Physician, Sacramento County Hospital.
 +
Government service: Chairman Medical Advisory Board No. 7,
 +
Sacramento, Cal.
 +
 +
Dr. Louis Hamman is Acting Physician-in-Chief to The Johns
 +
Hopkins Hospital and Acting Professor of Medicine, Johns Hopkins University.
 +
 +
Dr. F. M. Hanes is connected with Base Hospital No. 65, A. E. F.,
 +
France.
 +
 +
Dr. Henry Harris is Instructor in Medicine, University of California. Government service: Member of Medical Advisory Board,
 +
District No. 5, California.
 +
 +
Dr. R. F. Hegeman is Captain, M. R. C, and Is Assistant Chief of
 +
Base Hospital'No. 96.
 +
 +
Dr. Campbell P. Howard is Professor of Theory and Practice of
 +
Medicine and Clinical Medicine, State University of Iowa, and
 +
Physician to the University Hospital.
 +
 +
Dr. Henry T. Hutchins is Major, M. C, and is Surgeon-in-Chief,
 +
Evacuation Hospital No. 49, A. E. F.
 +
 +
Dr. J. Edwards Kerney is Visiting Urologist, Memorial Hospital,
 +
Pawtucket, R. I.; Visiting Urologist to Rhode Island State institutions; Associate Visiting Urologist to St. Joseph's Hospital,
 +
Providence, R. I.: and Surgeon in Urology to Rhode Island Hospital, O. P. D., Providence, R. I.
 +
 +
Dr. Clarence F. M. Leidy Is Captain, M. C, 62d Pioneer Infantry,
 +
Camp Wadsworth, S. C.
 +
 +
Dr. Hans Lisser is Instructor in Medicine, University of California Medical School, and Assistant Visiting Physician, University of California Hospital. Government service: Chief Examining Physician, Local Draft Board No. 4, Oakland, Cal.
 +
 +
Dr. Herbert M. Little has taken up again his work as Assistant
 +
Professor of Obstetrics and Lecturer in Gynecology, McGill University, after two years' duty overseas with the Canadian Army
 +
Medical Corps. He is also Assistant Attending Obstetrician, Montreal Maternity, and Assistant Attending Gynecologist, Montreal
 +
General Hospital.
 +
 +
Dr. David Russell Lyman is Medical Superintendent, Gaylord
 +
Farm Sanitarium, and Clinical Lecturer on Tuberculosis, Yale
 +
Medical School. He was for six months with the Rockefeller Commission for the Prevention of Tuberculosis in France, and with
 +
the Tuberculosis Bureau of the American Red Cross.
 +
 +
Dr. W. G. JlacCallum is Contract Surgeon, U. S. Army.
 +
 +
Dr. J. D. Madison is Captain, M. C, and is stationed in Milwaukee, Wis., as President of the Examining Board for Medical
 +
Officers' Training Camp, etc.
 +
 +
Dr. W. McK. Marriott is Professor of Pediatrics, Washington
 +
University Medical School, Physician-in-Chief to the St. Louis
 +
Children's Hospital, and Consulting Physician to the St. Louis City
 +
Hospital and the St. Louis Isolation Hospital.
 +
 +
Dr. Robert T. Miller is Lieutenant Colonel, M. C, Director U. S.
 +
Base Hospital No. 27, and Chief of Surgical Staff Mobile Hospital
 +
No. 1.
 +
 +
 +
 +
Dr. Ralph G. Mills, Assistant Resident Pathologist Johns Hopkins Hospital, is Professor and Head of Department of Pathology, '
 +
Peking Union Medical College, Peking, China (absent on leave).
 +
 +
Dr. George R. Minot, Jr., is Assistant Professor of Medicine,
 +
Harvard Medical School; Associate in Medicine, Massachusetts
 +
General Hospital, and Assistant Consulting Physician to Collis P.
 +
Huntington Memorial Hospital of the Harvard Cancer Commission.
 +
Dr. Roger S. Morris is Forchheimer Professor of Medicine, Medical Department University of Cincinnati; Director of the Medical
 +
Division Cincinnati General Hospital, and Director of the Outdoor
 +
Dispensary. Government service: Major, M. C, on duty abroad.
 +
 +
Dr. W. Bean Moulton is Captain, M. R. C, and is stationed at
 +
Camp Greenleaf, Chickamauga Park, Ga.
 +
 +
Dr. C. D. Parfitt is Lecturer on Medicine, University of Toronto,
 +
and Advisor to the Tuberculosis Clinic, General Hospital, Toronto.
 +
Dr. Francis W. Peabody is Assistant Professor of Medicine, Harvard Medical School; Physician to the Peter Bent Brigham Hospital, and Consulting Physician to the Collis P. Huntington Memorial Hospital. Government service: Major, M. C, on active
 +
duty in France.
 +
 +
Dr. Louise Pearce is Associate in Pathology at the Rockefeller
 +
Institute for Medical Research, New York City.
 +
 +
Dr. Clement A. Penrose is Major, M. R. C, at present on inactive
 +
duty.
 +
 +
Dr. H. W. Plaggemeyer is Captain, M. C, and is on active duty
 +
in France.
 +
 +
Dr. Alexander Randall is Captain, M. R. C, and is stationed with
 +
the 6th Army Corps, France.
 +
 +
Dr. George K. Rhodes is First Lieutenant, Medical Corps, U. S. A.,
 +
on duty at U. S. Base Hospital, Camp Meade, Md.
 +
 +
Dr. Hunter Robb is Major, M. R. C. He is stationed in the Medical Officers' Training Camp at Camp Greenleaf, Ga.
 +
 +
Dr. Peyton Rous is Associate Member, Rockefeller Institute for
 +
Medical Research, New York City, and Vice-Chairman, Division
 +
of Medicine and Related Sciences, National Research Council,
 +
Washington, D. C.
 +
 +
Dr. W. G. Sexton is First Lieutenant, M. C. He is on duty with
 +
U. S. Base Hospital No. 158, Camp Greenleaf, Ga.
 +
 +
Dr. W. F. Shallenberger is Associate Professor of Gynecology,
 +
Emory University; Visiting Gynecologist, Wesley Memorial Hospital; Visiting Gynecologist, Georgia Baptist Hospital, and Assistant Visiting Gynecologist, Grady Hospital, Atlanta, Ga.
 +
 +
Dr. Frank J. Sladen is Captain, M. C, and is Assistant Chief of
 +
Medical Service, U. S. Base Hospital, Camp Sherman, Ohio.
 +
 +
Dr. J. Morris Siemens is Major, M. R. C, and is Chief of the
 +
Surgical Service, U. S. Base Hospital No. 92, Cape Greene, N. C.
 +
 +
Dr. F. Janney Smith is Captain, M. C. He is Chairman, Cardiovascular Examining Board, and President, Certificate of Disability
 +
Board, 155th Depot Brigade, Camp Lee, Va.
 +
 +
Dr. Winford Smith is Colonel, Medical Department, U. S. A., and
 +
Chief of Bureau of Administration, Hospital Division, Surgeon
 +
General's Office, Washington. D. C.
 +
 +
Dr. Richard P. Strong is Major, M. C, and is stationed in France.
 +
Dr. Solomon Strouse is Assistant Professor of Medicine, Northwestern University; Attending Physician, Michael Reese Hospital;
 +
Director, Department of Medicine, Michael Reese Hospital Dispensary. Government service: Secretary and Member of Medical Advisory Board 3 J, Michael Reese Hospital.
 +
 +
Dr. Adrian Taylor, Assistant Resident Surgeon, The Johns Hopkins Hospital, is Professor of Surgery and Head of Department of
 +
Surgery, Union Medical College, Peking, China.
 +
 +
Dr. W. S. Thayer is Physician-in-Chief to The Johns Hopkins
 +
Hospital and Professor of Medicine, Johns Hopkins University.
 +
Government service: Brigadier General, M. C, U. S. Army, and
 +
Chief Medical Consultant, A. E. F., France.
 +
 +
 +
 +
Dr. Charles B. Thompson is Executive Secretary, Meulal Hygiene
 +
Society of Maryland: Psychiatrist at the Hebrew Hospital Dispensary, and Lecturer on Psychiatry to the Training School of the
 +
L'nion Protestant Infirmary.
 +
 +
Dr. Douglas Vanderhoof is Professor of Medicine in the Medical
 +
College of Virginia, Physician-in-Chief to the Virginia Hospital,
 +
Senior Attending Physician to the Memorial Hospital, and consulting Physician to the Johnston-Willis Sanatorium. Government
 +
service; Secretary Medical .-\dvisory Board No. 2. Richmond, Va.
 +
 +
Dr. Cecil \V. Vest is Captain. .M. C. and is stationed at Camp
 +
Meade, Md.
 +
 +
Dr. Carl \V. Waldron is Captain. C. A. M. C. O. C. The Canadian
 +
Unit. He is stationed at The Queen's Hospital, Frognel. Sidcup.
 +
Kent, England (for facial and jaw restorations).
 +
 +
Dr. Louis .M. Warfield is Major. M. C. and is Chief of the Medical
 +
Service, Jefferson Barracks. Mo.
 +
 +
Dr. S. Shelton Watkins is Lieutenant, M. C. U. S. Navy.
 +
 +
Dr. Ernest M. Watson is Instructor in I'rology. .Medical Department, University of Buffalo; Attending Urologist to Buffalo City
 +
Hospital, Municipal and Ernest Wende Hospital: Assistant Attending Urologist to Erie County Hospital, and Assistant in Clinical
 +
Urology, Buffalo General Hospital.
 +
 +
Dr. Charles W. Webb is Chief Surgeon to the Clifton Springs
 +
Sanitarium and Hospital. Clifton Springs, N. Y.
 +
 +
Dr. Harry 1. Wiel is Assistant in Medicine, University of California, and .Assisting Visiting Physician, San Francisco Hospital,
 +
San Francisco, Cal.
 +
 +
Dr. Gordon Wilson has taken up again his work in Baltimore
 +
after serving as Major, M. R. C. having been assigned to Camp
 +
.Meade as Tul>erculosis Specialist.
 +
 +
 +
 +
===Notes On New Books===
 +
 +
The liuntgcn Diagnosis of Diseases of the Alimenlary Canal. By
 +
Ri'sstax D. C.vKMAN, M. D., and Auiebt Miixeb, M. D. (Philadel/ihia: W. B. Saunders Company. 1917.)
 +
 +
It Is quite refreshing to read such a splendid description of the
 +
various methods and means of diagnosis as are put forth by Carman and Miller.
 +
 +
After a description of apparatus, technic and interpretation they
 +
take up the different organs and the various manifestations of
 +
disease as evidenced by rcpntgon examination.
 +
 +
Of especial value is the liescription of the normal findings before
 +
each chapter on the various organs, thus giving the student a much
 +
clearer conception of the pathologic states as outlined later. The
 +
idea of giving classified lists of roentgenologic signs in various
 +
diseases is noteworthy and a splendid idea.
 +
 +
Among other things which make the book graphic and impressive is the fact that practically all cases shown have been
 +
verified by operation and noted in the text— also the references at
 +
the end of each chapter prove to be another great asset.
 +
 +
Altogether the book is of great value — easy to read and understand because of the clearness of the text — the various points are
 +
graphically portrayed by splendid illustrations, and every subject
 +
receives thorough consideration from all points of view. It is a
 +
book which should be read by every rrentgenologlst as well as all
 +
practitioners interested in the roentgenologic diagnosis of gastrointestinal conditions, as It Is undoubtedly by far the foremost
 +
publication on the subject to-day. E. H. G.
 +
 +
 +
 +
===Publications===
 +
 +
 +
 +
The following six monographs :
 +
 +
Free Thrombi and Ball-Thrombi in the Heart. By J. H.
 +
Hewitt, M.D. 82 pages. Price, $1.00.
 +
 +
Benzol as a lyeucotoxin. By Laurence Selling, M. D. 60
 +
pages. Price, $1.00.
 +
 +
Primary Carcinoma of the Liver. By M. C. Winternitz,
 +
M. D. 42 pages. Price, 75 cents.
 +
 +
 +
 +
The Statistical Experience Data of The Johns Hopkins Hospital, Baltimore, Md., 1892-1911. By FitEDi:itiCK L.
 +
Hoffman, LL.D., F.S.S. 161 pages. Price, $2.00.
 +
 +
The Origin and Development of the Lymphatic System. By
 +
Florknce H. Sauin. 94 pages. Price, $2.00.
 +
 +
The Nuclei Tuberis Laterales and the So-called Ganglion
 +
Opticum Basalc. By Kdward F. Mai.one, M. D.
 +
Price, $1.50.
 +
 +
===The Johns Hopkins Hospital Reports===
 +
 +
Volume I. 423 pages, i)y plates.
 +
 +
 +
 +
Volume II. 570 pages, with 28 plates and figures.
 +
Volume III. 766 pages, with 69 plates and figures.
 +
Volume IV. 504 pages, 33 charts and illustrations.
 +
Volume V. 480 pages, with 32 charts and illustrations.
 +
 +
The Malarial Fevers ot Baltimore. By W. S. Thayer, M. D., and J. llEWETSON. M. D. „ „ ,r T>
 +
 +
A Study of some Fatal Cases ot Malaria. By Lewellts F. Barker, M. B.
 +
 +
Studies in Typhoid Fever. By William Osleb, M. D., with addlUon.il papers by G. Blomer, M. D..
 +
Simon Flbxnee, M. D., Walter Keed, M. D., and H. C. Parsons, M. D.
 +
 +
Volume VI. 414 pages, with 79 plates and figures.
 +
Volume VII. 537 pages with illustrations.
 +
 +
Volume VIII. 552 pages with illustrations.
 +
 +
Volume IX. 1060 pages, 66 plates and 210 other illustrations.
 +
 +
Contributions to the Science of Medicine.
 +
Dedicated by his Pupils to William Hbnrt Welch, on the twenty-flfth
 +
anniversary of his Doctorate. This volume contains 38 separate
 +
papers.
 +
 +
 +
 +
Volume X. 516 pages, 12 plates and 25 charts.
 +
 +
structure of the Malarial Parasites. Plate I. Bv Jesse W. Lazbab. M. D.
 +
 +
The Bacteriology of Cystitis, Pyelitis, and Pyelonephritis in Women, with
 +
a Consideration of the Accessory Etiological Factors in these Conditions, and of the Various Chemical and Microscopical Questions
 +
Involved. By Thomas R. Brown, M. D.
 +
 +
Cases of Infection with Strongyloides Intestinalis. (First Reported Occurrence in North America.) Plates II and III. By Richard P.
 +
SxRUNf:, M. D,
 +
 +
On the Pathological Changes in Ilodgkin's Disease, with Especial Reference
 +
to Its Relation to Tuberculosis. Plates IV-VII. By Dorothy M.
 +
 +
ItKED. M. D,
 +
 +
Diabetes Insipidus, with a Report of Five Cases. By Thomas B. Fctcher,
 +
 +
M. B. (Tor.).
 +
Observations on the Origin and Occurrence of Cells with Eoslnophlle Gn.ij
 +
 +
ulations in Normal and Pathological Tissues. Plate VIII. By W. T.
 +
 +
Howard. M, D.. and R. G. Perkins. M, D.
 +
Placental Transmissions, with Report ot a Case during Typhoid Fever. Bv
 +
 +
Frank W. Lynch. M. D.
 +
Metabolism in Albuminuria. By Chas. P. Emerson. A. B., M. D.
 +
Regenerative Changes in the Liver after Acute Yellow Atrophy. Plates
 +
 +
IX-XII. By W. G. MacCallcm, M. D.
 +
Surgical Features of Typhoid Fever. By Thos. McCrae, M. B., M. R, C. P.
 +
 +
(Lond.), and Jasies F. Mitchell. M. D.
 +
The Symptoms, Diagnosis, and Surgical Treatment of Ureteral Calculus.
 +
 +
By Ben.iamin R. Schenck, M. D.
 +
 +
 +
 +
Volume XI. 555 pages, with 38 charts and illustrations.
 +
 +
Pneumothorax ; A historical, clinical, and experimental study. By Charles
 +
 +
I'. E.MERSON. M. D.
 +
 +
Clinical Observations on Blood Pressure. By Henry W. Cook, M. D„ and
 +
 +
John B. Briggs. M. D.
 +
The value of Tuberculin in Surgical Diagnosis. By Martin B. Tinker.
 +
 +
M. D.
 +
 +
Volume XII. 548 pages, 12 plates and other illustrations.
 +
 +
The Connective Tissue of the Salivary Glands and Pancreas with its Development in the Glanduia Submaxillaris. Plates I-III, By Joseph
 +
Marshall Flint. M. I>.
 +
 +
A New Instrument for Determining the Minimum and Maximum BloodPressures in Man. Plates IV-X. By Jcseph Erlanger, M, D,
 +
 +
Metabolism in Pregnancy, Labor, and the I'uerperium. By J. Morris
 +
Slemons, M. D.
 +
 +
An Experimental Study of Blood-Pressure and of Pulse-Pressure in Man.
 +
Plates XI and XII. By Joseph Eklangke, M. D., and Donald R.
 +
Hooker, A. B., M. S.
 +
 +
 +
 +
By
 +
 +
 +
 +
Typhoid .\li.uiugitis. By RuFus I. Coi.e, M. D.
 +
 +
The Pathological Anatomy of Meningitis due to Bacillus Typhosus.
 +
William G. MacCallum. M. V.
 +
 +
A Comparative Study of White and Negro Pelves, with a Consideration
 +
of the Size of the Child and Its Relation to Presentation and
 +
Character of Labor in the Two Races. By Theodore F. Riggs. M. D.
 +
 +
Renal Tuberculosis. By George Walker, M. D.
 +
 +
 +
Volume XIII, 605 pages, with 6 plates, 201 figures, and
 +
1 colored chart.
 +
 +
studies in Genito-ITrinary Surgery.
 +
The Seven-Glass Test. By Hugh II. Young, M. D.
 +
The Possibility of Avoiding Confusion by Bacillus smegmatis (Smegma
 +
 +
bacillus) in the Diagnosis of Urinary and Genital Tuberculosis. An
 +
 +
Experimental Study. Bv Hugh H. Yoong. M. D., and John W.
 +
 +
Churchman. M. D.
 +
Urethral Diverticula in the Male. By Stephen H. Watts, M. D.
 +
An ITnusual Case of Urethrorrhagla. Bv H. A. Fowler, M. D.
 +
Paraurethritis. By John W. CHrRCHM.iN. M. D.
 +
Use of Ointments In the Urethra in the Treatment of Chronic Urethritis.
 +
 +
By Hugh H. Young, M. D.
 +
Treatment ot Stricture of the Urethra. By Hugh H. Yoono, M. D., and
 +
 +
John T. Geraghtt, M. D.
 +
The Treatment of Impermeable Stricture of the Urethra. By Hugh H.
 +
 +
Young. M. D.
 +
The Treatment of Bacterlurla by Internal Medication. By John W.
 +
 +
Churchman. M. D.
 +
Use ot the Cystoscope In the Diagnosis ot Diseases ot the Prostate. Bv
 +
 +
Hugh H. Y'oung, M. D.
 +
Chronic Prostatitis. An Analysis ot 358 Cases. Bv Hugh H. Young.
 +
 +
M. D.. John T. Geraghty, M. D., and A. R. Stevens, M. D.
 +
Modern Method for the Performance of Perineal Lithotomy. By Hugh H.
 +
 +
Young. M. D.
 +
Operative Treatment of Vesical Diverticula. Bv Hugh H. Young. M. D.
 +
Case of Double Renal Pelvis and Bifid Ureter, By Hugh II. Young, M. D.
 +
I'yonephrosis Due to Bacillus Typhosus. Bv Hugh H. Young, M. D., and
 +
 +
Louis C. Lehr, M. D.
 +
The Use of the X-ray in the Diagnosis of Renal and Ureteral Calculi. Bv
 +
 +
F. II. Baet.ier. M. D,
 +
Nephritis and H.-ematuria, By R. A. Fowler. M. D.
 +
The Microscopic Structure of Urinary Calculi ot Oxalate ot Lime. By
 +
 +
II. A. FOWLER, M, D,
 +
 +
Cystinuria with Formation of Calculi. By H, A, Fowler, M. D.
 +
Post-Traumatic Atrophy of the Testicle. By John W. Church.man, M. D.
 +
A Description of the Dispensary for Treatment of Genito-Urinarv Surgical
 +
Cases at The Johns Hopkins Hospital. By Hugh H. Young, M. D,
 +
 +
 +
 +
Volume XIV. 632 pages, with 97 figures.
 +
 +
Studies in Genito-Urinary Surgery.
 +
 +
The Treatment of Prostatic Hypertrophy by Conservative Perineal Prostatectomy. An analysis of cases and results based on a detailed
 +
report of 14.5 cases. By Hugh II. Young, M. D.
 +
 +
Recto-Urethral Fistulse. Description of New Procedures for their Prevention and Cure. By Hugh II. Young. M, D.
 +
 +
The Early Diagnosis and Radical Cure of Carcinoma ot the Prostate, being
 +
a study of 40 cases and presentation of a radical operation which
 +
was carried out In four cases. By Hugh H. Young, M. D.
 +
 +
 +
 +
Volume XV. 542 pages, with 87 illustrations.
 +
 +
Twelve papers on pneumonia. By Drs. Chatard, Fabyan, Emerson,
 +
Marshall, McCeae. Steiner, Howard and Haines.
 +
 +
A Study ot Diarrhoea In Children. By J, II. Mason Kso.k, Je., M. D., and
 +
EiiwiN II, Schorer. M. D.
 +
 +
Skin Transplantation. By John Staigb Davis, M. D.
 +
 +
Epidemic (jerebrospinal Meningitis and Serum Therapy at The Johns
 +
Hopkins Hospital. By Frank J. Sladen, M. D.
 +
 +
 +
 +
Volume XVI. 670 pages with 151 figures.
 +
 +
studies in the Experimental Production of Tuberculosis In the GenltoTlrinary Organs. By George Walker. M. D.
 +
 +
The Effect on Breeding of the Removal of the Prostate Gland or ot the
 +
Vesiculie Seminales, or ot Both : together with Observations on the
 +
Condition ot the Testes after such Operations on White Rats. By
 +
George Walker. M. D.
 +
 +
Scalping Accidents. By John Staige Davis. M. D.
 +
 +
Obstruction ot the Inferior Vena Cava with a Report of Eighteen Cases.
 +
By J. Hall Pleasants, M, I),
 +
 +
Physiological and Pharmacological Studies on Cardiac Tonicity in Mammals, By PERCIVAL Douglas Cameron, M. D.
 +
 +
 +
 +
The set of sixteen volumes will be sold, bound in cloth, for ninety
 +
dollars, net. Volume II will not be sold separately. Volumes I, III,
 +
IV, V, VI, VII, VIII, X, XI, XII, XIII, XIV, XV, XVI will be sold for
 +
$5,00, net, bound in paper, and $5.50, net, bound in cloth. Volume IX
 +
will be sold for ten dollars, net.
 +
 +
==Contents==
 +
 +
 +
Fluoroscopy of the Cerebral Ventricles. (Illustrated. t A Pliarmacological Appreciation of a BIhliral Reference to
 +
 +
By WAi.TtB E. Dandv J'J Mass Poisoning, 11 Kings IV, 3S-41. (Illustrated.)
 +
 +
Stereoroentgenogranis of tlie Injected Lung as an Aid to the B.v Uavid I. Maciit. A. B.. LL. B., M. D., F. S. .!.A. . 38
 +
Study of the Lung Architecture. (Illustrated.)
 +
 +
By William Snow Miller 34 Titles of Papers Appearing Uurini; the Year. Elsewhere than in
 +
 +
An Electromyographic Study of Chorea. (Illustrated.) the Bulletin, by Present and Former Members of the Hos
 +
By Stanlet Cobb, M.D 35 pital and Medical School Staff 42
 +
 +
 +
===Titles Of Papers Appearing During The Year Elsewhere===
 +
 +
Than In The Bulletin, By Present And Former Members Of The Hospital And Medical School Staff
 +
 +
Abel, J. J., and Pincoffs, M. C.
 +
 +
On the presence of albumoses in extracts of the posterior lobe of the
 +
hypophysis cerebri. — Utiid. Kockejeller Inst. M. Research, N. Y., 1918,
 +
x'xyiii, 193-203.
 +
 +
Atchley, D. W.
 +
 +
A study of eight cases of acute nephritis. — Arch. Int. ilcd.. Chicago,
 +
1918, xxii. 370-408.
 +
 +
Renal action in acute nephritis. — Proc. Soc. Exper. Biol. A lied., X. Y.,
 +
- 1917-18, XV, 85-88.
 +
 +
AUEB, J.
 +
 +
Generalized analgesia in cats after exposure to a war gas (CH3);S0,. —
 +
Proc. Exper. Biol, d Med., N. Y., 1918, xv, 104-106.
 +
 +
Localized pulmonary edema in cats after the inhalation of \yar gas
 +
I CH,)2S0,.— Ibid., 106-107.
 +
 +
AuEE, J., and Gates, F. L.
 +
 +
Experiments on the causation and amelioration of adrenalin in pulmonary edema. — Stud. Rocketeller Inst. M. Research, N. Y.. 1918,
 +
xxviii, 131-150.
 +
 +
AuER, J., and Kleixee, Isabel S.
 +
 +
Morphine hyperglycemia in dogs with experimental paucreatic deficiency. — J. Exper. M., Bait., 1918. xxvii, 49-03.
 +
 +
AuER, J., and Meltzer, S. J.
 +
 +
Lantern slide demonstration of the effect of magnesium sulphate upon
 +
tetanus. — Proc. Soc. Exper. Biol, d Med., N. Y., 191T-1S. xy. 36-37.
 +
The administration of epinephrin by intraspinal injections in acute or
 +
subchronic cases accompanied by a low blood pressure. — J. Am. M. .\ss.,
 +
Chicago, 1918, Ixx, 70-71.
 +
 +
Baer, W. S.
 +
 +
Arthroplasty with the aid of animal membrane. — Am. J. Orthop. Surg.,
 +
 +
Host., 1918, xvi. 1-29: 94-115; 171-199.
 +
 +
Primary and delayed primary suture in the treatment of war fractures.
 +
 +
— Am. J. Orthop. Surg., Bost., 1918, xvi, 513-519.
 +
 +
Also: J. Am, M. Ass., Chicago, 1918, Ixx, 1530-1533.
 +
 +
Baetjer, F. H.
 +
 +
Differential diagnosis of bone tumors. — Am. J. Roentgenol., X. Y.,
 +
1918, y, 261-264.
 +
 +
Baetjer, W. A., and Miller, S. R.
 +
 +
Bence-Jones proteinuria : some observations on its occurrence, with
 +
particular reference to nephritis and hypertension. — J. Am. M. Ass.,
 +
Chicago, 1918. Ixx, 137-139.
 +
 +
PoIIinosis or hay-fever : its specific treatment. — South. M. J. Birmingham, Ala., 1918, xi, 341-345.
 +
 +
Baetjer, W., Strong, R. P. let ah].
 +
 +
Report on progress of trench fever investigations. Trench Fever Commission of Medical Research Committee, American Reti Cross. — J. Am.
 +
M. Ass., Chicago, 1918. Ixx, 1597-1598.
 +
 +
 +
 +
Barker, L. F.
 +
 +
Heart murmurs. — Canada Lancet. Toronto, 1918, 11, 545-551.
 +
Endocrine functions and the digestive apparatus. — Med. d Surg.,
 +
St. Louis, 1918, ii, 655-678.
 +
 +
The general diagnostic study by the internist. — -V. York M. J. [etc.],
 +
1918, cvii. 489-493; 538-542; 577-582. Also: Med. Rec, N. Y., 1918,
 +
Nervous and mental symptoms in exophthalmic goiter. — J. Am. it. Ass.,
 +
Chicago, 1918, Ixxi, 327-329.
 +
 +
The value of the classics as a part of the studies preparatory to
 +
medicine. — South. M. J., Birmingham. Ala., 1918. xi. 391-394.
 +
Address in Medicine. On the significance of " heart murmurs " that
 +
may be found on examination of candidates for military service. —
 +
Canad. M. Ass. J., Toronto. 1918, viii, 577-585.
 +
 +
Oral sepsis and the digestive apparatus. — South. M. J., Birmingham,
 +
-Ala., 1918. xi, 481-484.
 +
The first ten years of the National Committee for Mental Hygiene, with
 +
some comments on its future. — Ment. Hyg., Concord, N. H., 1918, ii.
 +
557-581.
 +
 +
Barker, L. F., and Miller, S. R.
 +
 +
Perforating ulcer of the hard palate resembling tertiary syphilis. —
 +
J. Am. M. Ass., Chicago, 1918, Ixxi, 793-797.
 +
 +
Barker, L. P., and Rowntbee, L. G.
 +
 +
A report of a case of myrtol poisoning with comments upon the toxicity
 +
of eucalyptus oil and myrtoi in human beings and in animals. — Tr. Ass.
 +
 +
Am. Physicians, Phila., 1918, sxsiii.
 +
 +
Beall, K. H.
 +
 +
The diagnosis of nephritis. — Texas State J. M., Fort Worth. 1918, xiii.
 +
349-351.
 +
 +
Berey, J. M.
 +
 +
Action of the gluteus maximus
 +
strain. — AZftonj/ if. Ann., 1918,
 +
 +
Blackfan, K. D.
 +
 +
Lead poisoning in children.
 +
 +
 +
-Midland M. J., Birmingham. 191S, xvii.
 +
 +
 +
 +
Blackfan, K. D., and Maxcy, K. F.
 +
 +
The intraperitoneal injection of saline solution. — Am. J. Dis. Cliild.,
 +
Chicago, 1918, xy, 19-28.
 +
 +
Block, E. B.
 +
 +
The relation of oral sepsis to the nervous system. — South. If. ./.,
 +
Birmingham, Ala., 1918, xi, 606-609.
 +
 +
Bloodgood, J. C.
 +
 +
Some hernias that disqualify for military service, whether operated
 +
on or not. — J. Am. M. Ass., Chicago, 1918. Ixx. 515.
 +
A warning against operations for varicocele on applicants for enlistment, registrants for the selective draft and soldiers. — J. Am. M. Ass..
 +
Chicago, 1918, Ixx, 409.
 +
 +
Medical preparedness and medical and surgical problems in this war. —
 +
Penn. M. J.. Athens, Pa., 1918. xxi. 389-394.
 +
 +
Medical preparedness in the great drive for democracy. — South. M. J.,
 +
Birmingham, Alabama, 1918, xi, 51-56.
 +
 +
 +
 +
Aluo: Muruland M. J.. Unit.. T.HS. Ul. 1-0.
 +
 +
.ll»o; J. Florida it. Ast., St. Augustlue & .IiKksonvlllc, 1918. Iv, 2.-5
 +
How the iniliisirliil surgodii <'iin host co-operate with the GoTornniPut
 +
 +
ilurlog the war.--NoM/fc. M. ./., BlrmlnKhain, Ala.. 1918. xl. 45:t-4ri4.
 +
 +
The liiiportiince of recocnlzlng the weakness or the obllteralinn of the
 +
 +
ronjolneil temlon In operations for Infrulnal hernia. — South. H. ./..
 +
 +
BlrmlDKhnm, Alabama. 191S. il. 3e«S(i9.
 +
 +
AKo: ">»f. il. Kr<-.. Omaha. Neb.. 1918. xilll. SOl-.W".
 +
 +
Soldiers illsableil In the war. (Letter). — South, il. J., BirinlDgham.
 +
 +
Alabama. 1918. xl. r,-2i;X , „ ,
 +
 +
Some principles Involvlne the treatment of Infeeteil wounds. — ./. J/.rf.
 +
 +
At: Georgia. Augusta. 1918. vlll, 9-i:i.
 +
 +
Bloomfield, a.
 +
 +
Typhoid bacterlemla during the course of miliary tuberculosis. — .liii.
 +
Kei: Tuberc, Bait.. 191S. 11. 28-35.
 +
 +
Brem. W. v.. Rolling. G. E. and Caspee. E. J.
 +
 +
Pandemic Influenza and seiondarj- pneumonia at Camp Fremont. Calif.
 +
—J. Am. il. .!»».. Chicago, 191S. Ixxl. 21.38-2144.
 +
 +
Bribgman, E. W., and Hibose, K.
 +
 +
The effect of diuretics on the general blood pressure in animals with
 +
constriction of the renal arteries. — Arch. Int. Ued., Chicago, 1918. xxi.
 +
3.-1-.3.J3.
 +
 +
Brooks. B.. and Allison, N.
 +
 +
Arthroplasty: exp<TimentaI and clinical methods. — Am. ./. ()ilhiii>.
 +
Surg.. Boston. 1918, xvi, 83-93.
 +
 +
Brooks. B.. ScmMAciiER. H. W., and Wattenbero, J. E.
 +
 +
Intestinal obstruction: an experimental study. — Anil. Surg., I'hilii..
 +
1918. IXTll. 210-214.
 +
 +
Bbowx, T. R.
 +
 +
studies on some unusual tvpes of diarrhea. — ilcd. d Surg., St. I^ouis.
 +
1918. II. 640-«4.".
 +
 +
BiSTixG. C. H., Martin. H. G.. and Loeveniiabt. A. S.
 +
 +
The mori'hologlcal changes In the tissues of the rabbit as a result of
 +
reduced oxidation.—^, i'j-pcr. J/., Bait., 1918. xxvii, 399-412.
 +
 +
BlBNS, J. E.
 +
 +
The diagnosis and treatment of urlnarr Ilthlasls. — llVst Virg. it. J.,
 +
Huntington. 191s. xli. 280-291.
 +
 +
BfBNs, J. E.. and Hopkins, P. B.
 +
 +
A comparative study of the effects of thorium and other substances on
 +
the renal parenchyma when retained.— >/. Vrol., Bait.. 1918. 11. 145-1.')9.
 +
 +
BiBBOws. M. T.
 +
 +
A note on the mechanism of heart muscle contractions. — J. ilisaouri
 +
if. Atf.. St. liOUis. 1918. XT, 13S.
 +
 +
Why should autopsies be held? The argument to be used with relatives
 +
and friends. — Interstate it. J., Chicago, 1918. xxv. 700-763.
 +
 +
Burrows, M. T., and Neyjiann, C. A.
 +
 +
Studies on the metiiboilsm of cells In vitro. The toxicity of ilipeptiils
 +
for embryonic chicken cells. — i'ror. .S'oc. ICrpcr. Hiol. it iled., .N. Y.,
 +
1918. XV. 1.38139.
 +
 +
Camac, C. N. B.
 +
 +
Clinical report upon cases of lobar pneumonia treated with nnti
 +
Sieumococcus serum as observed at general hospital no. 6. Fort
 +
cFherson. Georgia. October. 1917. to May, 1918.— .4m.. J. M. Sc,
 +
Phila.. 1918. civi. 887-893.
 +
 +
Cameron. D. F.
 +
 +
Aqueous solutions of potassium and sodium iodlds as opaque mediums
 +
in roentgenography. Preliminary re|)ort. — /. .l»i. il. Asa., Chicago.
 +
1918. Ixx. 754-7.—I.
 +
 +
Camebon, D. F.. and Gbandy. C. C.
 +
 +
Sodium ami potassium Iodlds In roentgenographv.--./. .4m. .1/. Ana.,
 +
Chicago. 1918, Ixx. 1,'.I0-1.J17.
 +
 +
Campbei.l, C. M.
 +
 +
The r<^le of Instinct, emotion and personalllv in disorders of the heart.
 +
 +
With suggi-sllons for a clinical record. — ./. Am. il. .4»«., Chicago, 1918.
 +
 +
Ixil. 1021 1020.
 +
 +
A city school district and its subnormal children: with a discussion
 +
 +
of some soilal pmlilems lnv(dved and suggestions for constructive
 +
 +
work. — ilrnl. Iliig.. Concorii. .\. II.. 1918. li. 232-244.
 +
 +
A case of chlldhond conflicts with prominent reference to the urinary
 +
 +
system: with 8<ime general considerations on urinary symptoms In the
 +
 +
psyrhonru roses and psychoses. — I'fuchoanalut. Her., Wash., 1918. v.
 +
 +
269 290.
 +
 +
Carter, E. P.
 +
 +
F^irther observations on the aberrant electrocardiogram associated with
 +
sclerosis of the atrioventricular buniile branches and their tenninal
 +
arborizations, rilnical and histologic report of a case in which such
 +
aberrant complexes were obtained. — Arch. Int. iled.. Chicago. 1918.
 +
xxil. 331 3.'-,3.
 +
 +
Carter, E. P. and Wedd. A. M.
 +
 +
Report of a case of paroxysmal taehycarilia characterized by unusual
 +
control of the fost rhythm. — Arch. Int. iled., Chicago, 1918, xxil, 571!)80.
 +
 +
Casler. DeW. B.
 +
 +
Tetanus fnllnwlng laparotomy for ectopic pregnancy. Treatment hr
 +
subarachnoid injections of magnesium sulphate and anll-tetonlc
 +
serum — recovery —.Voiil A. il. ./,. Birmingham. Alo.. 1918, il, .-,12 .''.n;.
 +
 +
 +
 +
ider.- /ii; Hod. frol. (Cabot), 8°, Phila. Jt .V. Y.
 +
St. Uiuls
 +
 +
 +
 +
Cailk. J. R.
 +
 +
Infectious of the bla
 +
 +
1918. 11. 80-131.
 +
 +
The treatment of undescended testicle. — Interstate il.
 +
 +
1918. xxv. 2S.'.-2S0.
 +
 +
The diagnosis of diseases of the central nervous system by means
 +
 +
of the cystctscopic appearance of the bladder. — Interstate il. J.,
 +
 +
St. lyouis. 1918, xxv. 102-104.
 +
 +
Remarks on kidney surgery. — South, il. ./., Birmingham. .Ma.. 1918.
 +
 +
xi. 299-305.
 +
 +
Caclk, J. R., and Greoitzer, H. C.
 +
 +
Occluded renal tuberculosis, nutune])hrectomy. — iled. d Sun/., St. Louis.
 +
1918. ii. 4:.3-450.
 +
 +
Cecil, A. B.
 +
 +
An unique type of urethral obstrucllou.384.
 +
 +
 +
 +
^/. t rol. Bait.. 1918. 11. 379
 +
 +
 +
Eiper. il.. Bait..
 +
 +
 +
 +
Chesxey. a. II.. and CtLij^N, G. E.
 +
 +
A note on the production of acid l)y pneuiiuic
 +
1918. .\xvlil, 289-29i;.
 +
 +
Chesxey, A. M., and Moore, H. P.
 +
 +
A further study of cthylhvdrocui>rein toptochini In the treatment of
 +
acute lobar pneumonia. — Arch. Int. iled., Chicago, 1918, xxi, 059-081.
 +
 +
Churchman, J. W.
 +
 +
Melanosnrcoma of the rectum, with the report of a case. — .4m. J. il. Sc.,
 +
Phila.. 1918. dr. 039-044.
 +
 +
Treatment of acute infections of the joint bv lavage and direct meditation.—./. .4m. .U. .4«».. Chicago. 1!>I8. Ixx. 1047-10.')0.
 +
Fibroma of the tongue with consiileratlon of other tumors of the
 +
tongue an<I certain technical points in tongue resections. — iled. d
 +
Surg.. St. I>ouis, 1918. ii. 173-177.
 +
 +
A new incision for exposure of the lower abdomen and pelvis. — .liin.
 +
Surg., Phila., 1918, Ixvil, 180-182.
 +
 +
Clakk. a. H.. and Feltox, L. D.
 +
 +
A flltrable toxic product of the hemolytic streptococcus. — J. .4m. il.
 +
Ass., Chicago. 1918. Ixxl. 1048-1049.
 +
 +
Clark, J. G.
 +
 +
Medical teaching and research nftiT tli<
 +
1918. Ixxvlii. 220-2.30.
 +
 +
The therapeutic use of radium in gyncci
 +
Chicago. 1918. xxvi, 019-024.
 +
 +
Clarke, T. W.
 +
 +
The baby that •
 +
 +
 +
 +
war.— tm. J. Obtt., S. Y..
 +
ilogy. — Surg. Oynec. d Obst.,
 +
 +
 +
 +
ininot take milk.— trcd. Pcdint., X. Y.. 1918, xxxv, 193
 +
 +
 +
Clausen. S. W.
 +
 +
a method for the estimation of potassium in blood. — .1. Biol. Chem..
 +
 +
Bait., 191.S. xxxvi. 479-484.
 +
 +
The effect of injections of pituitary solution on (he urinary output in
 +
 +
a case of diabi'tes Insipidus.- .4 m. ./. Dis. Child., Chicago. 1918. xvi.
 +
 +
195-204.
 +
 +
Clausen. S. W.. and Mo.senthal, H. O.
 +
 +
The malntinance diet In diabetes meliitus as determined by the
 +
nitrogen equilibrium.— .Irc/i. Int. iled.. Chicago. 1918. xxl. 269-281.
 +
 +
Clausen, S. W., Mosentiial, H. O., and Hii.i.eb, Alma.
 +
 +
The effect of diet on blood sugar in eliabetis meliitus. — Arrh. Int. ilrd..
 +
Chicago, 1918, xxl, 93-108.
 +
 +
Cobb, S.
 +
 +
A note on the supposed relation of the sympathetic nerves to dccere
 +
hrate rigidllv. muscle tone, and tendon reflexes. — .Im. J. Physiol. Bait..
 +
1918, xlvl, 478-482.
 +
 +
Cole, R.
 +
 +
I'revenllon of pneumonia. — J. Am. il. Ass., Chicago. 1918. Ixxl. (',3.-i
 +
 +
0.39.
 +
 +
Pneumonia as a public health problem. — Kentucky il. J., 1918. xvi.
 +
 +
563-505.
 +
 +
Cole. R., and MacCallum, W. G.
 +
 +
Pneumonia ut a base hospital.
 +
1140-1 l.'.O.
 +
 +
CoxE, S. M.
 +
a methoil
 +
 +
 +
 +
42-43.
 +
 +
 +
 +
if studying nerv<
 +
 +
 +
 +
(^hlcago. 1918, ixx.
 +
 +
 +
 +
Im. ./. Orlhnp. Surg., Bost., 1918. xvi.
 +
 +
 +
 +
Some of the results of work on the pathology of peripheral nerve
 +
 +
Injuries- Im. ./. Orthop. Surg., UnDt.. 1918. xvi. 319.322.
 +
 +
Surgliiil pathology of the peripheral nerves. -Ilrit. .1. Surg . Bristol.
 +
 +
-mal nervi's and war injured nerves
 +
rath, d llaclcrlol, xxil, 1051 II.
 +
 +
 +
 +
1917 IV,
 +
 +
lllstolnglcal observations on
 +
 +
with the neurokeratin slain.
 +
 +
 +
Corner. G. W.. and Ht bni. F. H.
 +
 +
The non effect of corpus iuleum preparations on the ovulation cycle of
 +
the rat.— .4m. ./. I'hysiol., Bait., 1918. xlvl. 48.3486.
 +
 +
Cusiiiso, H.
 +
 +
A study of a series of wounds Involving the brain and Its enveloping
 +
 +
structures.- /Ir(». -1. Surg., Bristol. 1917-18, v. 5.1«.«84.
 +
 +
Notes on penetrating wounds of the brain. — Brit. il. J., Ixinil.. 1918. I.
 +
 +
221-220.
 +
 +
Dandy, W. E.
 +
 +
Extiniallon of the choroid plexus of the lateral ventricles In eommunl.nilng h^dnM ephalu". -.Inn. Surg.. Phila.. 1918. Ixvili. .-,09 .'.79.
 +
Ventriculogrnpbv folbiwlng the injection of air Into the cerebral
 +
ventricles— . I nil". Surg., Phila.. 1918. Ixvlii. 5-11.
 +
 +
 +
Davis, E. G.
 +
 +
Duodeno urptei-al fistiilii of spcmtanpoiis oriRin : report of a case. —
 +
J. Am. M. Ass.. Chicago. lOls. Ixx. ;;7(! ::7s.
 +
 +
Urinary antisepsis: a stiul.v of tlie antisi'ptic properties and the renal
 +
excretion of compounds related to phenolsulphonephthalein : preliminary report.— .7. Am. M. A.1S., Chicago, lOlS. lx.\, 581-585.
 +
 +
Davis, E. G., and Hain, R. F.
 +
 +
Urinary antisepsis. The antiseptic properties of normal dog urine. —
 +
J. Viol. Bait., 1918. ii, ;'.0S)-320.
 +
 +
Davis, E. G., and Harrell, B. E.
 +
 +
.Acriflavine in the treatment of gonorrhoea — an experimental and clinical study. — J. Urol., Bait.. 1918, ii, 257-27G.
 +
 +
Davis, E. G., and White, E. C.
 +
 +
Urinary antisepsis, further studies of the antiseptic properties and the
 +
renal excretion of compounds related to phenolsulphonphthalein. —
 +
J. Urol, Bait., 1918, ii. 107-127.
 +
 +
Urinary antisepsis. The secretion of antiseptic urine following the
 +
Intravenous administration of acriflavine and proflavine ; preliminary
 +
report. — J. Urol, Bait.. 1918. ii. 299-^07.
 +
 +
Davis, E. G., White, E. C, and Rosex, R.
 +
 +
Urinary antisepsis. The secretion of antiseptic urine following the
 +
intravenous administration of an organo-mercury phthalein derivative.—,/. Urol, Bait.. 1918. ii. 277-297.
 +
 +
Davis, E. G., and Young, H. H.
 +
 +
The surgery of the douhle kidney. Report of a case of resection of
 +
upper segment for calculous pyonephrosis. — Surg., Giincc. d Obst.,
 +
Chicago, 1918, xxvii. 1-l.S.
 +
 +
Davis, J. S.
 +
 +
The use of the pedunculated flap in reconstructive surgery. — .liiii.
 +
Surg., Phila., 1918. Ixviii, 221-230.
 +
 +
Davison, W. C.
 +
 +
The superiority of inoculations with mixed triple vaccine (B. typhosus.
 +
B. paratyphosus A. and B. paratyphosus B. ) over successive inoculations with the single vaccines, as shown by agglutinin curves in
 +
men and rabbits. — Arch. Int. Med., Chicago. 1918, xxi. 437-509.
 +
 +
Dawson, P. M.
 +
 +
I'nlversity ideals
 +
Pa.. 1918. n. s..
 +
 +
 +
 +
Sci€7ice, y. Y. and Lancaster.
 +
 +
 +
 +
-,r. Am. If. .Iss.. Chicago,
 +
 +
 +
 +
ilf. Ass.. Chicago. 1918. Ixxi. 63S-G39.
 +
 +
 +
 +
Dick, Gladys H., and Murray, Eleanor.
 +
The morphology of the inlluenza bacillus
 +
1918, Ixxi, 1568.
 +
 +
Dickson, E. C.
 +
 +
Botulism ; a further report of cases occurring In the Pacific Coast
 +
 +
States. — Arch. Int. lied., Chicago. 1918. xxii. 483-495.
 +
 +
Botulism. A clinical and experimental study. — Monogr. Rockefeller
 +
 +
Inst. it. Research, X. Y.. 1918. no. 8.
 +
 +
Botulism.— Bh//. Canadian Army M. Corps. 1918. i. 85-87.
 +
 +
Al.w: Canad. M. .4.i.s-. ,/., 1918, vill, 903-909.
 +
 +
Dickson, E. C, and Burke, G. E.
 +
 +
Botulism : a method of isolating Bacillus Botullnus from infected
 +
materials. — J. Am. M. Ass., Chicago, 1918, Ixxi. 518-521.
 +
 +
Felton, L. D., and Clark, A. H.
 +
 +
A Bltrable toxic product of the hemolytic streptococcus. — •/. .Im. J/.
 +
Ass., Chicago, 1918, Ixxi, 1048-1049.
 +
 +
Flexner, S.
 +
 +
Control of meningitis. — .7.
 +
 +
Dr. p-ranklln P. Mall ; an appreciation. — Science. N. Y. & Lancaster,
 +
 +
Pa.. 1918, n. s., xlvli. 249-2.54.
 +
 +
Flexner, S., and Awoss, H. L.
 +
 +
The passage of neutralizing substance from the blood into the cerelirospinal fluid in actively immunized monkeys. — J. Exper. M.. Bait..
 +
1918, xxvlii. 11-17.
 +
 +
FLEXNER, S., Amoss, H. L., and Eberson, F.
 +
 +
Physiological stimulation of the choroid plexus and experimeutal poliomyelitis. — J. Exper. M., Bait., 1918, xxvii. 679-687.
 +
 +
Flournoy, H.
 +
 +
Notes sur 4 cas d'obsessions et impulsions a debut instantan^. —
 +
( Coinmunication a la Soci^te Medicate de Gen&ve), Geneve, 1918.
 +
Kiludig. 24 pp. 8°.
 +
 +
l.'alcoi.iismt' et les enfants anormaux. — Extrait du xiii rapport de la
 +
Soriet*^ g^uevoise de patronage des Alleu^s. 1918, 16 pp. 8"^.
 +
 +
Ford, W. W.
 +
 +
I'tirther observations on the bacteria of the intestinal tract. — Tr. Ass.
 +
Am. Physicians, Phila.. 1918, xxxlli.
 +
 +
Fowler, H. A.
 +
 +
Anatomy, anomalies and injuries of the penis. — In: Mod. Urol
 +
(Cabot), 8°, Phila. & N. Y., 1918, I. 193-222.
 +
 +
FroNTZ, W. A.
 +
 +
Presentation of device facilitating the introduction of the cystoscope
 +
in certain difficult cases. — J. Urol, Bait.. 1918. ii. 39-41.
 +
 +
Froxtz, W. a., and Geraghty, J. T.
 +
 +
A study of primary hydronephrosis. — .7. Urol. Bait.. 1918. ii. 161-209.
 +
 +
Futcher, T. B.
 +
 +
Chronic hypertrophic pulmonary osteo-arthropathy following bronchiectasis. — Bull. Canad. Army Med. Corps. 1918, i. 38-40.
 +
 +
Career, J. R.
 +
 +
.\ iilea for prenatal care and the end-results of the h.vgiene of pregnancy.— Am. J. Obst., N. Y., 1918, Ixxviii. 506-575.
 +
 +
 +
 +
-.7. Indiana M.
 +
 +
Mod. Urol (Cabot). 8°, Phila. & X. Y..
 +
Mod. Urol (Cabot). 8". Phila. & X. Y..
 +
Radium. Pittsburgh. Pa.,
 +
 +
 +
 +
Phila.. 1917-lS.
 +
ngham, Ala.. 1918. xi.
 +
 +
 +
 +
locytic leukemia.
 +
 +
 +
 +
Gatch, W. D.
 +
 +
Some observations on the surgerV of the thyroid gland. Ass., Fort Wayne. 1918, xi, 13-17.
 +
 +
Geraghty, J. T.
 +
 +
Tumors of the bladder.
 +
 +
1918. ii. 187-244.
 +
 +
Tests of renal function
 +
 +
1918, Ii. 337-376.
 +
 +
The results of treatment of bladder tumor
 +
 +
1918. X, 77-85.
 +
 +
Geraghty, J. T., and Fbontz, W. A.
 +
 +
A study of primary hydronephrosis. — J. Urol, Bait.. 1918. ii. 101-209.
 +
 +
GiBBES, J. H.
 +
 +
Ilodgkin's disease; primary involvement of mediastinal glands with
 +
presentation of tumor mass over sternum. Blood-picture characteristic
 +
of well-advanced disease. Differential diagnosis. Etiology. Pathologic
 +
 +
anatomy. I'rognosis. Treatment. — Med. Clin *'
 +
 +
i. 1587-1594.
 +
 +
Oral sepsis an<l arthritis. — Sonth. M. ./.. Bii
 +
 +
489-492.
 +
 +
GiFFIN, H. Z.
 +
 +
Splenectomy following radium treatment fo
 +
Med. Rec, X. Y.. 1918, xciv, 1020-1023.
 +
 +
GiFFiN, H. Z., Sanford, a. H., and Szlapka, T. L.
 +
 +
Estimation of urobilin and urobilinogeu in the duodenal +++++
 +
CONTENTSs. —
 +
Am. J, M. Sc. I'hila.. 1918, civ. 562-579.
 +
 +
GOETSCH, E.
 +
 +
-Vewer methods in the diagnosis of thyroid disorders : pathological and
 +
clinical. — .V. York State J. M., N. Y.. 1918, xvili. 239-207. Also:
 +
Clifton Med. Bull, Clifton Springs, 1918. 1-12.
 +
 +
GOLDBAOH, L. J.
 +
 +
Nasopharyngeal tibro-myxoma. undergoing sarcomatous changes. —
 +
Laryngoscope, St. Louis. 1918, xxyiii. 106-108.
 +
 +
GOODPASTURE, E. W.
 +
 +
An anatomical study of senescence iu dogs, with especial reference to
 +
the relation of cellular changes of age to tumors. — J. Med. Research,
 +
Bost., 1918. xxxviil. 127-190.
 +
Observations on mitochondria of tumors. — Ibid., 213-224.
 +
 +
Goodpa.sture, E. W., and Jacobson, V. C.
 +
 +
Occlusion of the entire inferior vena cava by hypernephronm. with
 +
thrombosis of the hepatic vein and its branches. — Arch. Int. M..
 +
Chicago, 1918. xxii. 86-95.
 +
 +
GORHAM, L. W.
 +
 +
Xote on the diagnostic use of the X-ray in pneumonia, with especial
 +
reference to the position of the diaphragm. — .ilhany M. Ann., 1918.
 +
xxxix. 58-65.
 +
 +
 +
 +
.7. Physiol.
 +
 +
 +
 +
ulogy. — South. M. -/.. Birmingham.
 +
 +
 +
 +
eluding bands. —
 +
 +
 +
 +
Grey, E. G.
 +
 +
Observations on the postural activity of the sto
 +
Bait., 1918, xlv, 272-285.
 +
 +
Griffith, F. W.
 +
 +
Some of the common errors in gyne
 +
Ala.. 1918, xi. 40-42.
 +
 +
Gundrum, F. F.
 +
 +
Rat bite fever with report of two cases. — Calif. State J. M., San Fran..
 +
 +
1918, xvi, 16-18.
 +
 +
Nitro-benzol poisoning. — Calif. State J. M., San Fran.. 1918. xvi, 2o2
 +
 +
253.
 +
 +
Hain, R. F., and Davis, E. G.
 +
 +
Urinary antisepsis. The antiseptic properties of normal dog urine. —
 +
,J. Urol. Bait.. 1918. ii. 309-320.
 +
 +
Halsted, W. S.
 +
 +
Dilation of the great arteries distal to partial
 +
 +
Proc. Nat. Acad. Si:. Bait.. 1918, iv, 204-210.
 +
 +
Cylindrical dilation of the common carotid artery following partial
 +
 +
occlusion of the innominate and ligation of the subclavian. — Tr. .im.
 +
 +
Surg. Ass.. Phila.. I'.US, xxxyi.
 +
 +
Ijetter to Dr. Keen. Communication on the subject of the Carrel
 +
Dakin treatment of wounds. In: Keen, \V. W. The treatment of war
 +
 +
wounds, Phila.. 2. ed.. 1918, 252-259.
 +
 +
Harrell, B. E., and Davis. E. G.
 +
 +
Acriflavine in the treatment of gonorrhoea — an experimeutal and
 +
clinical study. — •/. Urol Bait., 1918. ii. 257-276.
 +
 +
Harrop, G. a., and Mosexthal. H. 0.
 +
 +
The comparativi- food yalue of protein, fat and alcohol in diabetes
 +
mellitus as measur. d bv the nitro.cen equilibrium. — Arch. Int. .Med.,
 +
Chicago. Iill8. xxii. 7.50-75S.
 +
 +
Hazex, H. H.
 +
 +
Syphilis and the war. — .4»i. ./. Syph., St. Louis. 191s
 +
 +
A more intensive form of arsphenamine therapy.
 +
 +
St. Louis. 1918, ii. 778-779.
 +
 +
More contract surgeons (Letter). — J. .\ni. M. Ass.
 +
 +
Ixx. 1184. „^„
 +
 +
Duties of the dermatologist. — J. Am. M. Ass.. Chicago. 1918. Ixx. 1989
 +
1990.
 +
 +
Dermatology and the war. — Med. if- Surg., St. Louis, 1918. ii. 145-l,.l.
 +
 +
Hiller, Alma, Mosenthal, H. O., and Clausen, S. W.
 +
The effect of diet on blood sugar in diabetes mellitus. —
 +
Chicago, 1918, xxi, 93-108.
 +
 +
 +
 +
. 144 135.
 +
im. ./. Syph..
 +
 +
Chicago. 1918.
 +
 +
 +
 +
Arch. Int. Med..
 +
 +
 +
 +
Februabt, 1919]
 +
 +
 +
45
 +
 +
 +
 +
Chi.ni:.!. 1!US. Ixxl.
 +
 +
 +
 +
Hl.NMAN, F.
 +
 +
Thi" nianagpiiicnt of siirKlcal risk: n review of 100 klilney iinil prostate
 +
0[H>rations. auil 50 eases of enlnr^d prostate Dot operated iipou. —
 +
Call/. Stole J. M.. San Fran.. 1!>1S. xvl. 2tl-::i."i.
 +
 +
A niodlfleatlon of CltzmaDH's syringe for iMSterlor urethral Insilllatlons.^. Am. .U. .!»«.. Chicago. lOlS. \x\. l:;!>i.
 +
 +
His.MAN, F.. and Lissek H.
 +
 +
Srpbllls of the epliUil.rmls without Involvement of the testicle : Itcporl
 +
of cage.— .Im. .;. S„i>h.. St. Louis. 1018, II. 4»i.'>-471.
 +
 +
HlBSCIIFELDEB, A. D.
 +
 +
The leaching ni pharmacology. — ,/. Am Jl
 +
tiU'.l-tilL'.
 +
 +
HiRscHFELDER. A. D., and Caxtwei.i,, W.
 +
 +
KITiMts of sonic aminii acl.ls upon the e.\clse<l segments of Intestine. —
 +
J. Pharmntol. d f.'j-pcr. Thcrap.. Bait.. 1018. xl. ITS.
 +
 +
HrrzBOT, J. M.
 +
 +
The effect of spleneetomv on the normal Imllvhliial and In certain
 +
pathological eoDilltlons.—' .4nn. Hurg.. I'hlla.. 11118. Ixvll. .i4()-."in.
 +
Myeloma of the clavicle.— -Inn. b'urg., Thlla.. 1018. IxvUl. ICIM.
 +
 +
HoL.MES, J. B.
 +
 +
Keccnt work In anatomy, physiology and pathology of childhooil.- Am. ./. l>iH. Ihil.. ('hlcuga, IftlS. xv. L'78-308.
 +
 +
 +
 +
Hooker, D. R.
 +
 +
The veno-pre.
 +
 +
 +
mechanism. — .liii. ./. I'hijHiol.. Bait.. lOlS. xlvl.
 +
 +
 +
 +
Hooker, D. R.. and Maciit. D. I.
 +
 +
Coueerning the action of the lodlile. bromide and nltnite Ions on the
 +
respiratory center. — ./. I'hnrmncol. A Expcr. Thcr<ii>.. 1018. xl. 113-G7.
 +
 +
HoPKixs, J. G., and Parker, Jilia T.
 +
 +
The effect of Injections of hemolytic streptococci on susceptible nnd
 +
insusceptible animals.—./. Exprr. J/.. Bait.. 1018. xxvU. 1-20.
 +
 +
Howard, C. P.
 +
 +
.Some of the medical lessons of the present war. — /. loira Sliitc U. .S'oc.
 +
Clinton. 1018. vlU. :t.-2.
 +
 +
Howard, C. P.. and I.ngvali>.sen-, T.
 +
 +
The mlm-ral metabolism of experimental s<urvy i<( thi- monkey. — L'vif.
 +
Iowa UonogrnphM, Studies In Med.. 1018. 1. 111).
 +
 +
Howard, C. P., and Steve.ns. F. A.
 +
 +
The Iron metabolism of hemochromatosis. — fiiir. loicii ilriHognipln-.
 +
Studies In Med.. 1018. 1. 1 IT.
 +
 +
Howell. W. H.
 +
 +
The coagulation of blood.— //nrrci; Lict.. lOli; IT. I'hila. & I,ond.. I'.Hs.
 +
JT2-:t2:t.
 +
 +
HowLAXD. J., and Marriott. W. M.
 +
 +
Ad.losls.— /'rnn. .1/. !.. Athens. I'a.. 101,8. xxl. 4i;0-4:!l!.
 +
 +
The Influence of a< Id phosphate on the elimination of ammonia hi I he
 +
 +
urini'.-.l rcA. Int. .Mrd.. Chicago. 1018. xxll. 4T7-48-.>.
 +
 +
Dbservatbms upon the calcium +++++
 +
CONTENTS of the hlood In Infantile tetany
 +
 +
anil upon the effeil of treatment by calcium. — Quart. ./. .Med.. Oxford.
 +
 +
1018, xl. 280-tlO.
 +
 +
Hf.NXEB, G. L.
 +
 +
Anatomy, abnormalities. Injuries and diseases of the ureter. — In: .Mud.
 +
 +
I rol. (Cabotl. 8°. Phlla. & N. V., 1018. II. 24."i-:tll.
 +
 +
A rare type of bladder ulcer. Further notes, with a report of eighlicMi
 +
 +
cases. — /. .On. .1/. !»».. Chicago. 1018. \xx. 2();t 212.
 +
 +
Kluslve ulcer of the bladder. Further notes on a rare type of bladder
 +
 +
ulcer, with a reiiort of twenty-live cases. — Am. ./. Obxf., N. Y.. 101s.
 +
 +
ixxviii. :it4-:hi.-..
 +
 +
The etlologv of ureteral lalculus. — .S'lirtf. (Ifinrr. .{ olml.. Chicago. I'.ils.
 +
xxvll. 2.'>2-2Tn.
 +
 +
HtRWITZ, S. H.
 +
 +
The value of renal functional studies In the prognosis and Ireiiliinnt
 +
if nephritis.- f'liUf. State ./. U.. San Fran.. 1018, xvl. 28T-20:i.
 +
 +
HtRWITZ, S. H.. and Falconer, E. H.
 +
 +
The %nlue of Unehtgen rays and benxene In the treatment of poly
 +
cythemla vera. — /. Am. .M. Afn., Chicago. 1018. Ixx. 114:!lU.-i.
 +
 +
HtRwiT7, S. H.. Meyer, K. F.. and Tacssio, L.
 +
 +
Studies on the Mooil proteins. III. Alliumln-globulln rallo In anillnxli
 +
Immunity. — /. Infrrl. /ii«.. Chicago. I'.ils. xxll. 1-2T.
 +
 +
.Iack, W. D., and Balleiil, L. C.
 +
 +
The use of fascial transplants in war surgery. — -.Inii. Sinu . I'bll.i .
 +
1018, IxvlU. 14.
 +
 +
Jaxe>vay, T. C. Richardson, H. B., and Park, E. A.
 +
 +
Kiperlmenis on the vasoconstrictor action of blood serum. — In/i fi;(.
 +
-Ved.. Chicago, 1018. xxl. .-.tl.'i-l!o:<.
 +
 +
Keidel, A.
 +
 +
rorasltologv anil serologv of syphilis. — .tin. ./. Suph.. St. I.<iuls. IOI>.
 +
II. 2Tii.2.sT. I No; South. .1/. ./., Birmingham. Ala.. 1018. xl. 2117 2T1.
 +
 +
Keidel, A., and Zim.mermann, E. L.
 +
 +
Tattooing and syphilis.— .tm. J. Spph.. St. Louis. 1018. I. 8.1. 00.
 +
 +
Keith, N. M.. and Thomson, W. W. D.
 +
 +
War nephritis, a clinical, functional, and pathological study. — (jiinri
 +
t. Sled., Oxford. 1018. xl. 220-200.
 +
 +
 +
 +
Kelly, H. A.
 +
 +
Fibroid tumors of the uterus treated with radium. — Charlotte |.V. f'.j
 +
 +
.U. ./.. 1018. Ixxvll. l.'i.-il.'lT.
 +
 +
Fibroid tumors and radium. — Virginia J/. Slonth.. Kichmouil. Va..
 +
 +
lOLs. xlv. IT,
 +
 +
Two hundn-d and ten fibroid tumors treated by radium. — 7'r. Am.
 +
 +
Olinrr. Soe.. rhila.. 1018. x||||.
 +
 +
The.Hlore Caldwell Janewav. 18T2-101T. — lloiton \l. Jt S. J.. 1018.
 +
 +
clxxlx. .-.'.iT-.-iO'l,
 +
 +
.loseph Trice. 18.-.:t-inil.— «o«foii, if. rf S. J.. 1018. dxxlx. 081-084.
 +
 +
.lohn llerr Miisser. 18.'i0-1012.— «osf. U. <t S. ./., 1018. clxxlx. 7T2.
 +
 +
lir. Kec nieillcal research. — Nciciicc. X. Y. & l.<incaster. Ta.. 1018.
 +
 +
n. s.. xlvli. 41!i.
 +
 +
Kempf, E. J.
 +
 +
Social and sexual behavior of monkeys with some comparable facts in
 +
human sexual behavior. — lAbstr.) Am. J. I rol.. .\. Y., 1018. xlv, 82-80.
 +
 +
Kino, J. T.
 +
 +
.\uscultation of pnlmonary apices in young men. — Mil. Surg.. Wash.,
 +
lois. xlll. ou r,.-.
 +
 +
Knox, J. H. M.
 +
 +
.Vjnericas debt In Iranci. -.1 m. ./. /»i«. Child.. Chicago. 1018. xvl, 212
 +
 +
Kracse, a. K.
 +
 +
Itest.— .Im. Iter. Tuhrrc. Halt.. 1018. I. 080-082.
 +
 +
Klenientarv concepts of tuberculosis.— .4m. Urr. Tuberc.. Ball.. 1018.
 +
 +
il. o:t-Ti.
 +
 +
I'redlsposllliin. < IMltorial.l— Im. Rer. Tubere.. Bait.. 1018, II. 43-48.
 +
 +
Tobacco smoke and pulmonarv tuberculosis. (Kdltorlal.) — .4in. Ker.
 +
 +
Tnlnre.. Hall.. 1018. II. OO-lO.-i.
 +
 +
Autlliiberculosls measures.— .4m. Her. Tubere.. Bait.. 1018, II. 037-0.":;.
 +
 +
Fssays on tuberculosis :
 +
 +
1. Before the tiitiercle bacillus.
 +
 +
2. Before Itobert Koch.
 +
:(. Hubert Koch.
 +
 +
4. The tubercle bacillus.
 +
 +
.'•. Infection: Introdiulory considerations.
 +
 +
0. Sources of infection : Cornels theory of dust Infection.
 +
 +
T. Infeclioii by inhalation : Fliigge's theory of droplet Infection.
 +
 +
8. Infection by Ingestion: part one.
 +
 +
!i. Infection by ingeslion : part two: the lirst experiments.
 +
 +
10. Infection by Ingestion: I'urt three: The occurrence of iMVlne
 +
bacilli in man.
 +
 +
11. Infection: special characteristics of tuberculous infection.
 +
 +
— /. Outdoor l.i/e. N. Y.. 1018. xv. 1-0: 30-41: fl.->-73 : 80; 101
 +
100: 120: 1201.17: 1031CO: 100.204.
 +
 +
— ./. Outdoor Lite. X. Y.. 1018. xv. 22ij-2:{0 : 24fl-2.'>0 : 20n-27.'i :
 +
 +
20."i-3OO.
 +
 +
^/. Oufrfooi- Life. X. Y.. 1018. xv, .{27-320: 342-344: :i03-:!fl7 :
 +
 +
374.
 +
 +
Lange, Linda B.
 +
 +
The complement Hxatlon test for tuberculosis.— Iwi. Iter. Tubere..
 +
Bait.. 1018. II. .-.41 ..4.".
 +
 +
Lawrence. J. S.
 +
 +
.\ studv of the aerobic bacteria found In wounds received on the batllellelil o^ the Somme.— i/iJ. Surgeon, Wash.. 1018. xlll, 140-1.13.
 +
 +
Levy. R. L.
 +
 +
The effect of thvrold secretion on the excitability of the endings of the
 +
cardiac vagus. — .4rr)i. Int. Ued.. Chicago. 1018, xxl. 203-208.
 +
 +
Levy. R. L., and Alexander, H. L.
 +
 +
The predisposition of streptococcus carriers to the compllcatlonH of
 +
measles. Uesults of separation of carriers from non-carriers at a hniie
 +
hospital.^/. .Im. .1/. Axu., Chicago. 1018. Ixx. IN2T I8:io,
 +
 +
Lis.'iER. H.
 +
 +
Svphllls of Ibe lung.— Im. ./. il.'Se.. I'hila.. liils. civ. :i.-.0-380.
 +
 +
The prevention of congenital svphllls by aullluellc prenatal Iberapy.
 +
Cnli). state .1 . M.. .San Fran.. 1018. xvl, 384:t88,
 +
 +
A not 1 the use of corpus luteum to prevent the palurul breasts
 +
 +
of menstruation. — F,ndoerinolog)i . (llendale. Cal.. lois. II. 12 l.^i.
 +
 +
L18SER, H., and Hin.max, F.
 +
 +
Svphllls of ihc cpl.lldvmls without Involvement of the lesllde: Keport
 +
of case.— Im. ./. s,iph.. SI. Louis. 1018. II. 40.% 4T1.
 +
 +
LoEVEXHART, A. S., BiNTiNo, C. H., and Martin. H. O.
 +
 +
The morphological changes In the tissues of the rabbll as a result of
 +
reduced oxidation.- ./. Kxper. J/.. Bull., 1018. xxvll. 3011 412.
 +
 +
Lyman, D. R.
 +
 +
The control of the careless consumptive.— Ira. Iter. Tubere.. Bait..
 +
1018. II. 30-42.
 +
 +
Following up the discharged sanatorium palleiit.- Im Her. fulirre..
 +
Ball.. 1018. 11. 01.-, (121.
 +
 +
MacCalli M, W. G.
 +
 +
I'albologv of the epidemic Hireptococcnl bronchopneumonia In lb.' army
 +
camps.—:/. Im. M. Am.. Chicago, 1018, Ixxl. 704-707.
 +
 +
MacCalli M, W. G., and Cole. R.
 +
 +
I'neumonia at a base hospital.-^/. .Im. M An,.. Chicago. 1018. In,
 +
1140.I1.-.0.
 +
 +
McCli RE, W. B., and Sai er. L. W.
 +
 +
Observations regarding Ihi' loss of water vapor through the skin In
 +
Infants.- Irr/i. Int. Sled . Chicago. 1018. xxl. 428-430.
 +
 +
MiCrae, T.
 +
 +
Tuberculosis am
 +
 +
 +
 +
iddler. — .Im. He
 +
 +
 +
 +
Ball.. lOIM. II. 372
 +
 +
 +
 +
46
 +
 +
 +
[No. 336
 +
 +
 +
 +
Macht, D. I.
 +
 +
Jewish food problems. — Jenish Forum, 1918, Nosi, l-U.
 +
A case of aspirin habit.— J/ed. Hec N. \. 1918. xciv, 't"- ,„,„.,„.,,
 +
 +
On the absorption of apomorphm and morphin through "uiji"-"
 +
channels.— Fcoc. 8oe. Exper. Biol. <C Med N Y., 191 --18, ^,y-,-^-- '  ,,
 +
On the comparative absorptive power for drugs of the bbuUler and
 +
urethra (male). — Proc. Soc. Exper. Biol. <C Med., N. \., lUli-lb. xv,
 +
 +
On the relation of the chemical structure of the opium alkaloids to
 +
their effect on smooth muscle and on the discoveiy of a new thHrapeutic
 +
a°ent as a consequence thereof. — Proc. Soc. Exper. Btol. d Med., >. 1..
 +
1§18. XV. 63-66. , ^ r ..t • 11 i,;,u
 +
On the relation between the chemical structure of the opium alkalouis.
 +
and their physiological action on smooth muscle with a pharm.iiological and therapeutic study of some benzyl esters : I. On the relation
 +
of the chemical structure of the opium alkaloids to their action on
 +
smooth muscle. II. A pharmacological and therapeutic study of some
 +
benzyl esters. — J. Pharmacol, d Eiper. Tlierap., Bait., 1918, xi, 389417 ' 419-446 .
 +
 +
On the absorption of drugs and poisons from the bladder and the
 +
urethra : I. Absorption of apomorphin and morphin. II. Absorption
 +
of various alkaloids, antiseptics, local anesthetics and salts. — J. L rol..
 +
Bait, 1918, 11, 43-49 ; 211-226. ,, ., „ x- v ims
 +
 +
On parotitis as a complication of influenza. — Mca. Hec, .^. i.. iJis,
 +
xciv, 1117.
 +
 +
Macht, D. I., and Hooker, D. R.
 +
 +
Concerning the action of the iodide, bromide and nitrate ions on the
 +
respiratory center. — J. Pharmacol, d- Exper. Thernp.. Bait., l.ilS, si,
 +
63-67.
 +
 +
Macht, D. I., Isaacs, S., and Gbeexberg, J. P.
 +
 +
On the influence of some opiates and antipyretics on the field of
 +
vision —Proc. Soc. Exper. Biol, d Med., N. Y.. 1917-18, xv. 4b-4S.
 +
On the influence of some antipyretics on the neuromuscular coordination test of •' tapping." — Proc. Soc. Exper. Biol, d Med., N. \., 191(18,
 +
XV, 61-62.
 +
 +
 +
 +
OS M. Soc, Topeka, 1918,
 +
Gynec. <f Obst., Chicago.
 +
 +
 +
 +
the presence of the meningococcus in the blood,
 +
birago, 1918, xxiii. 470-474.
 +
 +
 +
 +
Major, R. H.
 +
 +
Importance of focal infection in diseases of obi
 +
Herald, St. .Toseph. 1918, xxxvii, 159-163.
 +
Uremic ulceration of the intestine. — J. Kai
 +
xvlii, 136.
 +
 +
A study of the Krukenberg tumor. — Surg
 +
1918, xxvii, 193-204.
 +
 +
Major, R. H., and Black, D. R.
 +
 +
A huge hemangioma of the liver associated with heniangiomata of the
 +
skull and bilateral cystic adrenals. — .Iwi. J. M. Sc. Thila., 1918, clvi,
 +
469-483.
 +
 +
Marriott, W. M., and Howland, J.
 +
 +
The influence of acid phosphate on the elimin.ntion of ammonia in the
 +
urine. — Arch. Int. Med., Chicago, 1918, xxii, 477-482.
 +
Acidosis. — Penn. M. J., Athens, Pa., 1918, xxi, 429-436.
 +
Observations upon the calcium +++++
 +
CONTENTS of the blood in infantile tetany
 +
and upon the effect of treatment by calcium. — Quart. J. Med., Oxford,
 +
1918, xi. 289-319.
 +
 +
Marriott, W. M., and Sissos, W. R.
 +
 +
Variations in the lipoid ("tat") +++++
 +
CONTENTS of the blood of infants under
 +
certain nutritional conditions. — ^iii. J. Dis. Child., Chicago, 1918, xvi,
 +
75-82.
 +
 +
Marshall, H. W.
 +
 +
Structural deformities versus functional efficiencies as objects of treatments —BosfoH M. & 8. J., 1918, clxxviii, 708-712.
 +
 +
Revised ideas concerning toot defects and orthopedic footwear. —
 +
Boston M. d S. J., 1918, clxxviii, 428-432.
 +
 +
Maxcy, K. F.
 +
 +
Observations
 +
J. Infect. Di.
 +
 +
Maxcy, K. P., and Blackfax, K. D.
 +
The intraperitoneal injection of salin
 +
Chicago, 1918, xv, 19-28.
 +
 +
Mendenhall, Dorothy R.
 +
 +
Milk, the indispensable food for children. — T". S. Dept. I,abor. Children's Bureau. Care of Children Ser. No. 4, Bureau I'ubl., No. 3.i,
 +
Wash., Gov't I'rintlng Off., 1918.
 +
 +
Meyer, A.
 +
 +
Modern views and propositions on enforced treatment of mental
 +
diseases. — Maryland Psychiat. Q., Bait., 1918. vii.
 +
The mental hygiene movement.632-634.
 +
 +
Meter, A. W.
 +
 +
To Franklin Paine Mall. Ave Magister ! — Johns Hopkins Alumni May..
 +
 +
Bait., 1918, vi. 140.
 +
 +
Some observations on megacytes in lymphatic tissues. — Am. J. Anat.,
 +
 +
Bait.. 1918, xxiv, 91-104.
 +
 +
Studies on hemal nodes : VIII. The absence of hemal nodes in the
 +
 +
domestic pig. — Am. ./. Anat., Bait., 1918, xxiv, 109-120.
 +
 +
Miller, S. R., and Baetjeb, W. A.
 +
 +
Pollinosis or hay-fever: its specific treatment. — South. M. J., Biimiughani. Ala.. 1918. xi. 341-345.
 +
 +
Bence-.Tones proteinuria ; some observations on its occurrence, with
 +
particular reference to nephritis and hypertension. — J. .im. M. Ass..
 +
Chicago, 1918, Ixx, 137-139.
 +
 +
Miller, S. R., and Barker, L. F.
 +
 +
Perforating ulcer of the hard palate resembling tertiary syphilis. —
 +
J. Am. M. Ass., Chicago, 1918, Ixxi, 793-707.
 +
 +
Miller, W. S.
 +
 +
A study of the nerves and ganglia of the lung in a case of pulmonary
 +
tuberculosis.— Am. Rev. Tuberc, Bait.. 1917-18, i, 123-139.
 +
 +
 +
 +
solution. — Am.
 +
 +
 +
 +
Vhild.,
 +
 +
 +
 +
-banad. M. Ass. J., Toronto, 1918, vlil.
 +
 +
 +
 +
Mills, C. W., and Hendersox, J. T.
 +
 +
The effect of pulmonary tuberculosis on renal function. — -4m. Aei;.
 +
Tuberc, Bait.. 1917-18, i, 573-597.
 +
 +
Mllls, C. W., and Forster, A. M.
 +
 +
The treatment of laryngeal tuberculosis by reflected condensed sunlight.— -Vat. Ass. Study d Prev. Tuberc, Tr., 1918, xiv.
 +
 +
Mills, R. G. . ,. , u h,
 +
 +
.lapanese medical literature. Review of current Pf^^'o^'cals by the
 +
staff of the research department. Severance t nion Medical College.
 +
Seoul. Korea.— Chino M. J., Shanghai, 1918, xxxu, 49-6o , 2o6--bi .
 +
An'^unSsuarcaseof double carcinoma with extreme resistance to one
 +
and death from the effects of the other.— C7mia M. J., Shanghai, 1918.
 +
xxxii.
 +
 +
Mills, R. G., Ludlow, A. I., and Vax Biskirk, J. D.
 +
 +
A simple method of water purification tor itinerant missions
 +
other travellers.— CftiJiO M. J., Shanghai. 1918, xxxu,, 13.-14o.
 +
 +
'^Pathologic hemorrhage. A group of cases illustrating this condition
 +
with a note on the early diagnosis of pernicious anemia.— Metf. tlni.
 +
X. Am., Phila., 1918, i, 1102-1124.
 +
 +
MixoT, G. R., and Loeb, R. F. „ , ,/ .
 +
 +
An attempt to prevent influenza at Harvard College.— Boston if. cCS. J., 1918, clxxix, 665-669.
 +
 +
 +
 +
ries and
 +
 +
 +
 +
-Surg.
 +
 +
 +
 +
' ""p^^mature separation of the .norm.allv implanted placenta.
 +
Oynec. Ob.it., Chicago, 1918, xxvi. 133-138.
 +
 +
Morris, R. S., and Friedlaxder, A. . ,. - i,- ,„
 +
 +
The significance of presystolic thrill in the examination of soldieis.—
 +
J. Am. M. Ass., Chicago, 1918, Ixxi, 3.o-3(i.
 +
 +
^"'RenaTJ'unf.^io^- as measured by the elimination of,^fl"^;^|- /"J^ ?nd
 +
nitrogen, and the specific gravity of the tivine. H- !«« ejie" -if, inS
 +
low and normal diets.— .Ircft. Int. Med. (^^^'^"SO. l^H-J^"- '-O^SO^,War nephritis, by P Ameiiille ..Transl. from the French by H. t.
 +
Mosenthal.— J^. Urol., Bait., 1918, ii, d1-106.
 +
 +
Mosexthal, H. O., and Clausex, S. W. • , k h, „»,„
 +
 +
The maintenance diet in diabetes mellitus as determined by the nltiogen eQuilihrium.— .liTji. Int. Med., Chicago, 1918. xxi, 269--S1.
 +
 +
MO.SEXTHAL, H. O., ClAUSEX, S. W and HiLLER ALMA
 +
 +
The effect of diet on blood sugar in diabetes mellitus.— lif/i. /»' Mca..
 +
Chicago, 1918, xxi, 93-108.
 +
 +
MOSEXTHAL, H. 0., and Harrop, G. A. , , ^,. ,:,,„.„- „,pi
 +
 +
The comparative food value of protein, f«^-XV'^» ™h" ' 'l'-'"';**''' f"^'"
 +
litus as measured by the nitrogen equilibrium.— .liOi. Int. ilea.,
 +
Chicago, 1918, xxii, 750-758.
 +
 +
Neymaxx, C. a., and Burrows, M. T. . . ^ ,- . ,
 +
 +
studies on the metabolism of cells i""''", ,, The toxicity of dipept.d,
 +
for embryonic chicken cells.— Proc. Soc. Lxpc. Biol, d ilea., -n. i.,
 +
1918, XV, 138-139.
 +
 +
 +
 +
-Ann. Surg.. Phila.. 191S. Ixvii,
 +
 +
 +
 +
Nrsox, P. I.
 +
 +
Inflammatory tumors of the abdoinen.306-311.
 +
 +
Infantilism and other hypoplastic conditions of the uterus.—/. Am. M.
 +
Ass., Chicago, 1918, Ixxi. 1101-1107.
 +
 +
^'rhe^ pathological effects of Phthirus pubis.— Porasitoioffi/, London.
 +
1918. X. 375-379. .^ , , j i oi c ., -ja^ jn".
 +
 +
The biology of Phthirus pubis.— Pai-asi<o7off!/, Lond., 1918, x, 3S3-4Uo.
 +
 +
NuTTixG, M. Adelaide. „„„,.,„„ vi„<,c*
 +
 +
War-time problems of the nursing profession. — lohns Hopkins .\uises
 +
Alumna: Mag., Bait., 1918, xvii, 93-100.
 +
 +
Opie. E. L., Baetjer, W. [et all. . ^. ,^ . „ ^^^
 +
 +
Report on progress of trench fever investigations. Trench lever
 +
Commission of Medical Research Committee, American Red Cross.—
 +
J. Am. M. Ass., Chicago, 1918. Ixx. 159i-lo98.
 +
 +
Opie, E. L., and Wobus, R. E.
 +
 +
Elephantiasis : report of a case.9S7.
 +
 +
OsLER, Sir W. ,„,„ • -^i -..
 +
 +
Typhoid spine.— B"». Canadian Army M. lorps l^l;^- i- 'S.;-'Graduated exercise in prognosis. — Lancet, ixinii., i.iis. i, -oi.
 +
The rimary examination for the F R. C. S. Eng. ; an appeal to the
 +
President of the Royal College of Surgeons.— Lancet, Lond.. 191S, i.
 +
 +
Medicine in America (Speech to University Extension Stiidents,
 +
summer meeting at Cambridge).- The Hospital, Lond., 1918, Ixiv, 43o.
 +
 +
The utility of artificial pneumothorax in the treatment of phthisis. —
 +
Canada Lancet, Toronto, 1918-19, Hi, 64- 1 2.
 +
 +
P\rk, E. a., Jaxeway, T. C, and Richabdsox, H. B.
 +
 +
Experiments on the vasoconstrictor action of blood serum.— 4rc/i. Int.
 +
Med.. Chicago, 1918, xxi, 565-603.
 +
 +
Patox, S. ,.,.,,,
 +
 +
Effects of low oxygen pressure on the personality ot the aviator.
 +
J Am. M. Ass., Chicago, 1918, Ixxi, 1399-1400.
 +
 +
 +
 +
Am. M. Ass.. Chicago. 1918. Ixx.
 +
 +
 +
 +
Februakt, 1919]
 +
 +
 +
47
 +
 +
 +
 +
Peabody, F. W.
 +
 +
Ciinliuc ilfspnea.— Jm. J. J/. iV., Phlln.. 1918. civ. 100117.
 +
 +
Cardiac dyspnea. — Harvey Led., 1910-17. Phlla. 4 lA>nd.. lOlS, 24S
 +
•J71.
 +
 +
Peabody, F. W., Clovgu, H. A., Stubgis, C. C. {ft al.\
 +
Effects of tbo Injection of eplnepbrln In soldiers with " irritable heart."
 +
rrelimlnary report. — J. Am. J/. Aat., Chicago, 1918, Ixxl, 1912-1913.
 +
 +
Peabce, Louise, and Bbowx, W. H.
 +
 +
Kxporiiiioutnl ir.vp;iutiiioiiii:isis : its application in chemotberapeiitkInvestlgations. — J. Exper. 11., Bait., 1918, IxviU, 109-147.
 +
 +
Pesbose, C. a.
 +
 +
 +
 +
Plaooemeyeb, H. W.
 +
 +
Kadicnl treatment for veslco-vaginal flstuln. — Grate Hasp. Bull..
 +
Detroit. 191718. 11. 17-19.
 +
 +
QUINBY. W. C.
 +
 +
Anatomy and pbTsiolog; of the cidney. — In: Hod. fro/. (Cabot), 8°.
 +
 +
r-bila. & N. Y.. lins. 11. 312-3.-16.
 +
 +
Anutumv and phvslologv of the prost;ite and seminal vesicles. — In:
 +
 +
Mod. Int. (CalMiti. S . Phlla. Jt N. Y.. 1918. 1, 541-552.
 +
 +
The treatment of genital tuberculosis in the male. — J. Am. if. Ass..
 +
 +
Chicago. 1918. Ixxl. 1790-179G.
 +
 +
Richaedsox, E. H.
 +
 +
Note on saphenous varljt simulating a femoral hernia. — Ann. Surg.,
 +
 +
Phlla.. 1918. Iivll. 471-472.
 +
 +
Interpretation of lumbo-SJicral backache in women. — South, if. J.,
 +
 +
Birmlngliam. Ala.. 1918. xi. 139-144.
 +
 +
The effect of hysterectomy upon ovarian function. — Tr. Am. Oynec.
 +
 +
Soc, I'hila.. 1918. xliii.
 +
 +
Richardson, H. B., Jaxeway, T. C, and Pabk, E. A.
 +
 +
Experiments on the vasoconstrictor action of blood serum. — Arch. Int.
 +
Hcd., Chicago. 1918. xil. 565-003.
 +
 +
Roses, R., Davis, E. G., and White, E. C.
 +
 +
Urinary antisepsis. The secretion of antiseptic urine following the
 +
intravenous administration of an organo-mercury phthaleln derivative.
 +
— J. Crol., Bait.. 1918. II, 277-307.
 +
 +
Rocs, P.
 +
 +
Method for Intravenous Injection of guinea pigs. — ./. Exper. it.. Bait .
 +
 +
191, <(, xivll. 4.->9-462.
 +
 +
I'rinary slilcmsls. Hemosiderin granules In the urine as an aid In
 +
 +
the diagnosis, of pernicious anemia, hemochromatosis, and other dis
 +
 +
eases causing slilerosis of the kidney. — J. Exper. if.. Bait., 1918. xxvlil.
 +
 +
645-659.
 +
 +
Rovs, P.. and Olheb, J.
 +
 +
Experimental hemochromatosis
 +
644.
 +
 +
 +
 +
Exper. if., Bait.. 1918, xxvlil, 02;
 +
 +
 +
 +
Rois, P.. and Robebtso.n, O. H.
 +
 +
Free antigen and antibody circulating together in large amounts
 +
(hemagglutinin and agglutinogen In the blood of transfused rabbits). —
 +
J. Exper. .1/.. Halt., r.iis. xxvli. 509-517.
 +
 +
Autobemagglutluutlun experimentally Induced by the repeated withdrawal of blood— J. Exper. J/., Ball., 1918. xxvll. 563-508.
 +
 +
Roi s. P., and Wilson, G. W.
 +
 +
hiuld substitutes for transfusion after hemorrhage; first communica
 +
tion. — J. Am. it. Aat., Chicago, 1918, Ixx, 219-222.
 +
 +
Rowxtree, L. G.
 +
 +
Syphilis in its medical its general, and its sociological aspects —
 +
Therap. Qai., Detroit, 15»1S, n. s., xxxTiti, 222-225.
 +
 +
Row-ntbee, L. G., and Bakker. L. F.
 +
 +
a report of a case of myrtol poisoning with comments upon the toxlcltv
 +
of eucalyptus oil and myrtol In human beings and In animals. — Tr.
 +
Alt. Am. Phyticiant, I'hila., 1918, xxxlli.
 +
 +
Rl'SIIMORE, S.
 +
 +
Progress In gynecology. — Boston if. <f S. J., 1918, clxxviil, 633-539.
 +
 +
Sabix, Fi.OBExrE R.
 +
 +
Franklin Paine Stall: a review of bis scientific achievement. — Science,
 +
N. Y. & Lancaster, Pa., 1918. n. s., xivll, 254-261.
 +
 +
Sampson. J. A.
 +
 +
The escape of foreign material from the uterine cavity into the nl.Tlii.veins.— .tm. J. Obst., N. Y., 1918, Ixxvlii, 161-175.
 +
 +
SeM-ards, a. W.
 +
 +
Viii. Ill- .lis. nrery and associated conditions. — ifed. Clin, X. Am.. Phlln..
 +
1141.
 +
 +
• if tropical sunlight with special reference to phot"
 +
: — J. Hcd. Research, Bost.. 1918. xxxvlll, 293-334.
 +
•n of dilute sodium hydroxld on certain races of the
 +
pri, ,11,,,,, .„ , ,i.._v. .4m. .If. Ass.. Chicago. 1918. Ixxl. 1301-1.303.
 +
The treatment of amcrblc dysenterv with chaparro amargosa casli'ln
 +
nicholsonl. — J. Pharmacol, rf Exper. Therap., Bait, 1918. xl, 331.
 +
 +
Sellabds. a. W.. Spooseb, L. H., and Wyman. J. H.
 +
 +
Serum treatment of type I pneumonia. — J. Am. if. Ass., Chicago. 19I.K
 +
Ixxl. 1310 IMll.
 +
 +
Sharpe. W.
 +
 +
Diagnosis and treatment of brain Injuries with or without fracture of
 +
 +
the skull.— .4m. ./. Surg., X. Y.. inis. ixxll. 109-114.
 +
 +
The operativ., treatment of trifacial neuralgia. — Ann. Surg., Phlla..
 +
 +
19IS. Iivill. .".71-.T7S.
 +
 +
Kecent advances In neurological surgery and especially in the diagnos!"
 +
 +
and treatment of brain Injuries— CJiorfoMc (.V. CI If. J., Ixxvll. 2.T1
 +
 +
 +
erlpheral facial
 +
 +
 +
 +
the time of labor. — Am. J. Obst..
 +
 +
 +
 +
Operative treatment In selected cases of chronic perl
 +
paralysis. — J. Am. it. Ans., Chicago. 1918. Ixx. 13541357.
 +
Recent advances In the surgery of the brain and spinal cord.— ./ourriar.
 +
I.ancct. .Minneapolis. 1918. xxxvlll, 313-318.
 +
 +
Fractures of the skull : the resulting intracranial pathology and the
 +
treatment.— .»/cd. rf Surg.. St. Ixiuis. Mo., 1918, 11. 319-333
 +
Observations regarding neurological surgerv. and especially the diagnosis and treatjnent of brain injuries. — J. Tenn. if. Ass., .Nashville.
 +
 +
Observations regarding the iliagnosis and treatment of brain Injuries
 +
with or without a fracture of the skull. .l/iiiiir»«f<i I/.. I'MS. I. ;;n,-,
 +
SlMON, C. E.
 +
 +
A manual of clinical diagnosis by means of laboratory methods. —
 +
9. ed.. Phlla. & Lond.. 1918. Lea & Feblger. 851. p. 80.
 +
The probable association of amino-aciduria with Bence- Jones |iroteinurla. — J. Am. it. Ass., Chicago, 1918, Ixx, 224.
 +
 +
SiSSOX, W. R.
 +
 +
A critical review of intestinal bacteriology in relation to certain
 +
diarrheas of infants.- f<o»(on if. rf ,S. J., 1918. clxxviil. 492-408.
 +
 +
Sissox, W. R., and Mabriott, W. M.
 +
 +
Variations in the lipoid ("fat") +++++
 +
CONTENTS of the blood of Infants under
 +
certain nutritional conditions. — .4m. J. Dtt. Child.. Chicago, 1918 xvl
 +
75-82.
 +
 +
Sladex, F. J., and Friedlandeb, A. [et al].
 +
 +
The epidemic of Influeniia at Camp Sherman, Ohio. — J. Am. i/. .4<r»..
 +
Chicago. 1918. Ixxl. 1052-1650.
 +
 +
Slemons, J. M.
 +
 +
The significance of fever
 +
1918. Ixxvlii. 321-328.
 +
Analysis of the blood In
 +
06sf.. N. Y.. 1918. Ixxvll.
 +
 +
S.MITII. W. H.
 +
 +
How nurses are meeting the present needs. — Im. ,/. Surging. Uorhester.
 +
 +
N. Y.. 1917-1918, xvlll. 979-989.
 +
 +
The civil hospital ami its duties in war time. lAbstr.l. — Trained
 +
 +
Xurse [etc.), N. Y.. 1918. Ix. 1315.
 +
 +
Medical aspects of the war. — Johns Hopkins Alumni Hag., Bait., 191S
 +
 +
vl, 348-307.
 +
 +
Some ospects of the nrognim of the medical department of the armv
 +
 +
and their effect on civil hospitals. — ifod. Hasp., St. Louis. 1918 xl
 +
 +
334-330.
 +
 +
Si'EBBY, J. A.
 +
 +
Results following operative treatment of pelvic inflammatory tilsea«e
 +
in the Standford University Clinic. — Calil. State J. .»., San Fran 1918
 +
xvl, 388-390.
 +
 +
 +
 +
Stevens, A. R.. and Petebs, J. P., Jb.
 +
 +
A study lu war nephritis; a new condition associated with henior
 +
rhages in the bladiler wall and urinary symptoms: prellminarv
 +
report.^T/. Im. J/. Ass., Chicago. 1918. Ixx. 1760-1703.
 +
 +
Stboxo, R. p.
 +
 +
Etiidogy and method of tninsmlssion of trench fever. — Bull Arad dc
 +
it(d. Par., 1918. 3. s, Ixx.
 +
 +
Stboxo, R. P.. Swift, H. F. fef at].
 +
 +
Trench fever. Report of Commission Medical Research Committee.
 +
American Red Cross. [London], 1918. Ox/ord Vnirersity Press, 446.
 +
 +
Report on progress of trench fever Investigations. Trench Fever Commission of Medical Research Committee, .\merlcan Red Cross. — J 4m
 +
if. Ats., Chicago. 191S. ixx. 1597-159S.
 +
 +
Report on progress of trench fever Invesllgations of Trench Fever Commission of Medical Research Committee. American Red Cross. — ifrd
 +
ItuU. Par.. 191,s. I, 370-383.
 +
 +
Strovse, S.
 +
 +
.Juvenile diabetes in twins, (he Karell treatment of edema. The Importance of details In the treatment of angina pectoris. — .Ifrd. VUn. X.
 +
Am., Phila., 1917-18. I. 12411259.
 +
 +
Stbouse. S., and Bi.ocii, L.
 +
 +
Notes on the present epiilenilc of respinitorv disease. -./. .Im. Jf. .4»»
 +
Chicago. 1918. Ixxl. l.')08 1571.
 +
 +
Tiieoiiai.d. S.
 +
 +
Chief function of oblique tnuscles of the
 +
1918. xil. 57.59.
 +
 +
VoKGTLix, C, and Mvkiis. C. N.
 +
 +
Phosphorus as an lnc|lcator of the vitamin
 +
 +
 +
 +
-iird .standard. Chic
 +
 +
 +
 +
+++++
 +
CONTENTS of corn and
 +
 +
 +
 +
products. -/'Mil. Health Itep., Wash., 1918. xxzlll. 911-911
 +
Wabfield, L. M.
 +
 +
vilhout acute onset. — J. Am. .If. Ass..
 +
 +
 +
 +
Chronic emiocardltis '
 +
I91S. Ixxl. 970!iil.
 +
The eti..li>gy of nrlerlo
 +
III. 115<11i.
 +
I.<ictosurla : case pn-f
 +
ronsln it. J., 1917IS,
 +
 +
 +
 +
onset.
 +
clerosls.-^f. fall, rf fl(»i. .v., St. IjO\i\». 1917-18.
 +
nting unusual fentiiri's. cllnlrni n-porl. — Mis
 +
 +
 +
 +
Warfield. L. M.. and Smith. F. M.
 +
 +
Studies on Irritable heart; preliminary report.
 +
Chicago. 1918. Ixxl. 1815-1816.
 +
 +
Watson. E. M.
 +
 +
The development of the semlDit T(»IcIp(i In man.—
 +
xxlv. 305-435
 +
 +
 +
 +
wl.. 191 s
 +
bacilli ill
 +
 +
 +
 +
conslileralli.n of th<- methods for di'moiislrnilng tubercle
 +
the urin.-.— .4m. J. .W. Sr , Phlla.. lOIS elvl, 6.36-643.
 +
Xoten iin the recognition of certain le»ions of the male bladder. -.4nn
 +
Hurg.. Phlla., 1018. Ixvil. 06102.
 +
 +
 +
 +
The human seminal vesicles at birth, with observations on their fetal
 +
development. — Ann. Surg., Phila., 1918, Ixviii, 416-419. Also: Tr. .
 +
Hect. Oenito-Urin. Dts. Am. M. Ass., Chicago, 1918, Ixix.
 +
The essentials of success in prostatic surgery. — Canad. M. Ass. J.,
 +
Toronto, 1918, viii, 327-332.
 +
 +
The place of Intraspinal therapy in urology. — J. Am. M. Ass., Chicago,
 +
1918, Ixx, 296-300. ,
 +
 +
The developmental stages of the human seminal vesicles. — J. Urol,,
 +
Bait., 1918, ii, 129-139. '<
 +
 +
The structure of the verumontanum — a study of the origin and devel- •
 +
opment of its inherent glandular elements. — J. Urol., Bait., 1918, ii,(f
 +
337-351. j;
 +
 +
Watts, S. H.
 +
 +
.\cute and subacute pancreatitis. Report of seven cases. — Ann. Surg.,
 +
I'hila., 1918, Ixvii, 278-292.
 +
 +
The treatment of certain forms of subacute pancreatitis. — Surg., Oynec.
 +
d out., Chicago, 1918, xxvii, 286-288.
 +
 +
Weeb, C. W.
 +
 +
Surgical treatment of goiter. — N. York State J. il., N. Y., 1918, xviii,
 +
272-278. Also: Clifton Med. Bull., Clifton Springs, 1918, 12-18.
 +
 +
Welch, W. H.
 +
 +
Letter to S. Adolphus Knopf, M. D. An introduction to " What the
 +
American soldier now fighting in France should know about tuberculosis," by S. Adolphus Knopf. — J. Outdoor Life, N. Y., 1918. xv. 14.
 +
 +
Whipple, G. H., and Cook, J. V.
 +
 +
Proteose intoxications and injury of body protein. IV. The metabolism
 +
of dogs with sterile abscess, pancreatitis, and pleuritis. V. The increase in non-protein nitrogen of the blood in acute inflammatory
 +
processes and acute intoxications. — J. Expcr. 11., Bait., 1918, xxviii, ,
 +
223-241 ; 243-252.
 +
 +
Whipple, G. H., and Van Slyke, D. D.
 +
 +
Proteose intoxications and injury of body protein. III. Toxic protein
 +
catabolism and its influence upon the non-protein nitrogen partition of
 +
the blood. — ./. Exper. M., Bait., 1918, xxviii, 213-221.
 +
 +
White, E. C, and Davis, E. G.
 +
 +
Urinary antisepsis. The secretion of antiseptic urine following the
 +
intravenous administration of acriflavine and proflavine preliminary
 +
report.—./. Urol., Bait., 1918, ii, 299-307.
 +
 +
White, E. C, Davis, E. G., and Rosen, R.
 +
 +
Urinary antisepsis. The secretion of antiseptic urine following the,
 +
intravenous administration of an organo-mercury phthalein derivative.
 +
— J. Urol, Bait., 1918, ii, 277-307.
 +
 +
Williams, J. W.
 +
 +
.\ consideration of some of the anatomical factors concerned in the
 +
production of deformed pelves. — Am. J. Obst., N. Y., 1918, ixxvii. 714758.
 +
 +
 +
 +
WOLFSOHN, J. M.
 +
 +
The predisposing factors of war psychoneuroses. — J. Am. M. Ass.,
 +
Chicago, 1918. Ixx, 303-308. Also: Lancet, Lond., 1918. i, 177-180.
 +
The treatment of hysteria ; successful results of a rapid re-education
 +
methoi' — ./. Am. .U. Ass., Chicago, 1918, Ixxi, 2057-2062.
 +
 +
WOOIXEY, P. G.
 +
 +
Three cases which illustrate the consequences of coronary lesions. —
 +
 +
J. Lab. t£- Clin. M., St, Louis, 1917-18, iii, 192-198.
 +
 +
-Meningitis at Camp Greene. — ./. Lab. & Clin. M., St. Louis, 1917-18,
 +
 +
iii. 409-412.
 +
 +
Three cases of parietal aortic thrombosis. — J. Lab. <G Clin. Med.,
 +
 +
St. Louis, Mo., 1917-18. iii. ,-i39-347.
 +
 +
Convulsions. ( Editorial, i—-/. Lab. .£ Clin. M., St. Louis, 1917-18, iii,
 +
 +
719-720.
 +
 +
Yates, J. L.
 +
 +
Surgical methods in the treatment of malign affections of superficial
 +
lymphatic tissue. — Surg. Oimec. it Obst., Chicago, 1918, xxvii, 156-162.
 +
Observations of a Wisconsin medical officer in France. — Wisconsin
 +
M. J., Milwauliee, 1917-18, xvi, 476-477.
 +
 +
Young, H. H.
 +
 +
Cancer of the prostate. —
 +
 +
1918. i, 657-719.
 +
 +
Sarcoma of the prostate.
 +
1918, i. 720-722.
 +
 +
Calculus disease of the prostate. — In: Mod. Urol. (Cabot), 8°, Phila. &
 +
 +
N. Y.. 1918, i, 723-724.
 +
 +
The employment of the high frequency current for the extraction of
 +
 +
calculi incarcerated in the lower end of the ureter. — J. Urol., Bait.,
 +
 +
1918, ii, 35-38.
 +
 +
A new operation for epispadias. — ./. Urol.. Bait.. 1918. ii, 237-251.
 +
 +
Recent progress in the treatment of cancer of the prostate, seminal
 +
 +
vesicles and bladder. — South. M. J., Birmingham, Ala., 1918, xi, 120
 +
129.
 +
 +
Excision of vesical diverticula after intravesical invagination by
 +
 +
suction ; a new method. — Surg. Gynec. <t- Obst., Chicago, 1918, xxvi,
 +
 +
125-132.
 +
 +
Presentation of a radical operation for tuberculosis of the seminal
 +
 +
tract. — Surg. Oynec. A Obst.. Chicago. 1918. xxvi, 375-384.
 +
 +
Changes in trigone due to tuberculosis of kidney, ureter, and bladder.
 +
 +
Bridge formation and floating trigone. — Surg. Gynec. cC Obst., Chicago,
 +
 +
1918, xxvi, 608-615.
 +
 +
Young, H. H., and Davis, E. G.
 +
 +
The surgery of the double kidney. Report of a case of resection of
 +
upper segment for calculous pyonephrosis. — Surg. Gynec. d Obst.,
 +
Chicago, 1918. xxvii, 1-13.
 +
 +
Zimmerman, E. L., and Keidel, A.
 +
 +
Tattooing and syphilis. — Am. J. Syph., St. Louis, 1918, i, 83-96.
 +
 +
 +
 +
2Iod. Urol. (Cabot), 8°, Phila. and N. Y.
 +
i; Mod. Urol. (Cabot), 8°, Phila. & N. Y.,
 +
 +
 +
 +
PUBLICATIONS.
 +
 +
 +
 +
The following six monographs :
 +
 +
Free Thrombi and Ball-Thrombi in the Heart. By J. H.
 +
Hewitt, M. D. 83 pages. Price, $1.00.
 +
 +
Benzol as a Leucotoxin. By Laurence Selling, M. D. 60
 +
pages. Price, $1.00.
 +
 +
Primary Carcinoma of the Liver. By M. C. Winternitz,
 +
M. D. 42 pages. Price, 75 cents.
 +
 +
 +
 +
The Statistical Experience Data of The Johns Hopkins Hospital, Baltimore, Md., 1892-1911. By Frederick L.
 +
Hoffman, LL.D., F.S.S. 161 pages. Price, $2.00.
 +
 +
The Origin and Development of the Lymphatic System. By
 +
Florence K. Sabin. 94 pages. Price, $2.00.
 +
 +
The Nuclei Tuberis Laterales and the So-called Ganglion
 +
Opticura Basale. By Edward F. Malone, M. D.
 +
Price, $1.50.
 +
 +
 +
 +
==Contents==
 +
 +
Antituberculosis Measures. By Allen K. Kraisi: 49
 +
 +
Insusceptibility of Monkeys to Inoculation With HlooJ From Measll•^ Patients. (Illu>tiiitcd.> By Andrew Watson Sellards ami John A. Wentwortii S"
 +
 +
The Production of Tetany by the Intravenous Infusion of Sodium liicarbonate. Report of an Adult Case.
 +
 +
By George A. Harrop, Jr 6
 +
Changes in the Blood Immediately Following Transfusion.
 +
 +
By John G. Huck, M. D. 03
 +
 +
Elizabeth Fry — Quaker Reformer. (Illustrated.!
 +
 +
Bv Henry M. Thomas 72
 +
 +
 +
 +
Sixteen days after this injection, this animal was reinoculated with measles blood taken from a patient (C) wirhin
 +
from four to six hours after the rash had appeared. The
 +
blood was mixed with an equal part of 2 per cent sodimn
 +
citrate in physiological saline. Of this mixture 15 c. c. were
 +
injected intraperitoneally. On the following day, 24 hours
 +
later, another injection was made with blood taken from a
 +
patient (D) 12 hours after the appearance of the rash. This
 +
specimen of blood was diluted with an equal part of physiological saline and dcfibrinated ; 20 c. c. of this defibrinated mixture were injected intraperitoneally. After another interval of
 +
24 hours a final injection was made with the blood of Patient
 +
E, taken not later than 12 hours after the rash had appeared.
 +
One part of blood was mixed with two parts of physiological
 +
saline and 20 c. c. of the defibrinated mixture were injected
 +
intraperitoneally. The efPect of these injections is given in
 +
Chart I. The temperature charts of these patients are also
 +
given. (Chart IV.)
 +
 +
Monkey II was kept under observation for 10 days. Blood
 +
for injection was taken from Patient B within from 6 to
 +
12 hours after the first appearance of the rash. The specimen
 +
was mixed with an equal part of physiological saline and
 +
20 c. c. of the defibrinated mixture were injected intraperitoneally. The white blood counts and temperature of this
 +
animal are given in Chart II. The temperature of the patient
 +
is recorded in Chart IV. Before injection this animal had
 +
a marked erythema o\ er the face and eyebrows ; a few macules
 +
were also present. This ra.sli faded during the first week of
 +
the incubation period, but increased somewhat 10 days after
 +
inoculation, mough its intensity was not so great as during
 +
 +
 +
 +
the period before injection. Since this time it has fluctuated
 +
considerably. At present, two months after the last injection, it is more marked than at any time during the incubation periods. Twelve days after the first injection of blood
 +
this monkey received injections of measles blood on three
 +
successive days ; these injections were exact duplicates of those
 +
just recorded for Monkey I, the same specimens of blood being
 +
used.
 +
 +
Monkey III. This animal, a young adult, was given a
 +
series of three injections simultaneously with Monkeys I and
 +
II. The same specimens of blood were employed though
 +
the details were different. The injection on the first day
 +
consisted of 8 c. c. of the mixture of citrated blood injected
 +
into the heart and 12 c. c. intraperitoneally. On the second
 +
and third days 30 c. c. of the defibrinated mixtures were
 +
given intraperitoneally. Tlie results in this monkey are
 +
recorded in Chart III.
 +
 +
REFERENCES
 +
 +
1. Hektoen: Jour. Infect. Dis., 1905, II, 238.
 +
 +
2. Anderson and Goldberger: Public Health Reports, 1911.
 +
XXVI, 847 and 887; Jour. Am. Med. Assn., 1911, LVII, 113, 476
 +
and 971.
 +
 +
3. NicoUe and Conseil: Compt. Rend. Acad. Scien., 1911, CLIII,
 +
1522.
 +
 +
4. Hektoen and Eggers: Jour. Am. Med. Assn., 1911, LVII, 1833.
 +
 +
5. Tunnicliff: Jour. Infect. Dis., 1912, XI, 474.
 +
 +
6. Lucas and Prizer: Jour. Med. Research, 1912, XXVI, 181.
 +
 +
7. Ricketts and Wilder; Jour. Am. Med. Assn., 1910, LIV, 463.
 +
 +
8. Tunnicliff: Jour. Infect. Dis., 1918, XXII, 462.
 +
 +
9. Plotz: Jour. Infect. Dis., 1915, XVII, 1.
 +
 +
 +
 +
THE PRODUCTION OF TETANY BY THE INTRAVENOUS INFUSION
 +
 +
OF SODIUM BICARBONATE
 +
 +
REPORT or A'm ADULT CASE
 +
 +
By George A. Hakrop, Jr.
 +
 +
(From the Medical Clinic of The Johns Hoiiki>is Hospital)
 +
 +
 +
 +
Many drugs and chemicals have been mentioned as causing
 +
tetany in adults. Following Frankl-Hochwart,' it has been
 +
customary to classify all these conditions in one group, as due
 +
to toxins or poisons. The clinical history of a patient with
 +
tetany which was produced, or at least precipitated, liy intravenous infusions of sodium bicarbonate follows :
 +
 +
L. H. Medical No. 39293. Colored. Aged 22. Domestic. Admitted, March 8, 1918. Died, March 18, 1918.
 +
 +
The family and past history were unimportant, except that the